重庆市4例输入性疟疾死亡病例调查及诊疗分析  

Investigate,diagnosis and treatment analysis of 4 imported malaria death cases in Chongqing

作　　者：谭妍[1] 许静茹[1] 周杨[1] 蔡娇娇[1] 向尧 罗飞[1] TAN Yan;XU Jing-ru;ZHOU Yang;CAI Jiao-jiao;XIANG Yao;LUO Fei(Chongqing Center for Disease Control and Prevention,Chongqing 400042,China)

机构地区：[1]重庆市疾病预防控制中心,重庆400042

出　　处：《中国热带医学》2021年第11期1114-1116,共3页China Tropical Medicine

摘　　要：目的分析2013—2019年重庆市输入性疟疾病例中4例死亡病例的特征,总结死亡原因。方法收集4例疟疾死亡病例的流行病学调查报告、实验室指标、临床特点等进行回顾性分析。结果4例疟疾死亡病例均为非洲输入性恶性疟男性病例,从发病到确诊的平均时间为8.3 d,初期临床表现多样,包括非典型症状牙痛、腹痛腹泻、乏力等。实验室检查主要异常表现为血小板计数、红细胞数目、血红蛋白浓度、嗜酸性粒细胞百分比降低;总胆红素、间接胆红素、丙氨酸氨基转移酶、天冬氨酸转移酶升高,总蛋白、白蛋白降低,尿素、肌酐升高;凝血指标纤维蛋白原升高,心肌酶谱指标中羟丁酸脱氢酶、乳酸脱氢酶升高;静脉血恶性疟原虫环状体密度高,2例患者存在恶性疟原虫配子体。4例患者初诊均误诊,其中2例未进行抗疟治疗,1例在死亡前一天、1例在死亡当天进行静脉滴注青蒿琥酯及对症治疗。4例患者均错过了最佳救治时间,皆因多脏器功能衰竭而死亡。结论恶性疟疾发病初期临床表现可能不典型,容易误诊、误治。应提高外出务工人员的防疟意识,加强对出入境人员的宣传教育,同时提高临床医生对疟疾的诊治意识和水平,及早诊断,在血液中的疟原虫密度高时及时给予抗疟原虫治疗以降低原虫密度。对症支持治疗控制并发症,对防止恶性疟病例死亡意义重大。Objective To analyze the characteristics and causes of 4 malaria death cases.Methods Retrospective analysis was performed for the data of epidemiological survey,laboratory indicators and clinical characteristics in 4 malaria death cases.Results Four malaria patients dead from P.falcipanum were male adults,imported from Africa.The average time from onset to diagnosis as malaria was 8.3 d.The initial clinical symptoms were varied,including atypical toothache,abdominal pain,diarrhea and fatigue.The main abnormal results of laboratory examination were decreased of PLT,RBC,HGB,and eosinophil percentage;increased of TB,IBIL,ALT,AST;decreased of TP,ALB;increased of UN,Cr;increased of blood coagulation index Fib and myocardial enzyme index HBDH,LDH;The density of P.falciparum ring form was high in venous blood,and falciparum gametophytes were present in 2 cases.All 4 patients were misdiagnosed due to initial diagnosis.Two patients did not receive antimalarial treatment before death,one patient received intravenous infusion of artesunate and symptomatic treatment on the day before death and one patient received the day before death.All the 4 patients died of multiple organ failure due to misdiagnosis,missing the best treatment time.Conclusions Early clinical manifestations of P.falcipanum may not be typical,easy to be misdiagnosed and mistreated.When the density of plasmodium in blood is high,timely anti-malarial treatment is given to reduce the density of plasmodium,and symptomatic treatment is used to control complications.It is of significance for preventing deaths from P.falcipanum to improve the awareness of migrant workers on malaria prevention and the awareness and ability of diagnosis and treatment of clinicians.

关 键 词：疟疾 恶性疟 临床症状 死亡 

分 类 号：R531.3[医药卫生—内科学]