输入性恶性疟疾与合并COVID-19病例临床特征的对比分析  

Comparative analysis of clinical features in imported falciparum malaria and combined COVID-19 cases

作　　者：张开义 李翔 卢潇 张美娜 刘永莉 张乐 ZHANG Kaiyi;LI Xiang;LU Xiao;ZHANG Meina;LIU Yongli;ZHANG Le(Department of Interventional Tuberculosis,the Third People's Hospital of Kunming(Yunnan Clinical Medical Center for Infectious Diseasese),Kunming,Yunnan 650041,China;不详)

机构地区：[1]昆明市第三人民医院(云南省传染性疾病临床医学中心)介入结核病科,云南昆明650041 [2]昆明市第三人民医院(云南省传染性疾病临床医学中心)医学影像,云南昆明650041 [3]昆明市第三人民医院(云南省传染性疾病临床医学中心)重症医学科,云南昆明650041

出　　处：《热带医学杂志》2023年第4期503-507,共5页Journal of Tropical Medicine

基　　金：昆明市卫生健康委员会卫生科研课题项目(2020-03-08-0010)。

摘　　要：目的分析输入性恶性疟疾病例与合并新型冠状病毒肺炎(COVID-19)病例的临床特征、临床分型、预后、化验资料及影像学改变。方法选取昆明市第三人民医院2022年8月收治的10例确诊为输入性恶性疟疾病例,收集一般资料、临床特征、实验室检查指标、影像学表现、临床分型及预后,依据有无合并新型冠状病毒(SARS-CoV-2)感染分为感染组(n=4)与合并感染组(n=6),对比分析两组资料差异性。结果与感染组比较,合并感染组平均发病时间缩短1 d,病程延长5 d,高热与超高热均在感染组出现(100%,4/4),严重贫血、精神障碍与肾功能损伤危重病例表现均出现在合并感染组,感染组4例病例中2例患者出现轻、中度肝损害及黄疸,而合并感染组6例病例中、重度肝损害及黄疸占83.33%,肾功能不全占50.00%。恶性疟原虫检测结果显示,合并感染组环状体3例,小滋养体3例;感染组环状体1例,小滋养体3例。感染组1例、合并感染组2例伴有影像学改变。结论恶性疟疾患者合并SARS-CoV-2感染除了出现发热热型改变、合并肝功能损伤以外,还出现咳嗽、贫血、精神障碍及肾功能损伤,实验室资料出现淋巴细胞百分比升高、肝功能损伤程度加重、疟原虫密度显著升高,影像学改变与COVID-19相符,结合临床表现变化与早期借助特异性病原学及疟原虫筛查可减少延迟诊断及漏诊。Objective To analyze the clinical characteristics,clinical typing,prognosis,laboratory data and imaging changes of imported falciparum malaria cases and combined coronavirus disease 2019(COVID-19)cases. Methods A total of 10 cases diagnosed with imported falciparum malaria admitted to the Third People's Hospital of Kunming in August2022 were selected to collect general information,clinical characteristics,laboratory test indexes,imaging manifestations,clinical typing and prognosis,and were divided into infection group and combined infection group based on the presence or absence of combined severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection,and the differences between the two groups were compared and analyzed. Results Compared with the infection group,the average onset time of the coinfection group was shortened by 1 d and the duration of the disease was prolonged by 5 d. Ultrahyperpyrexia and hyperthermia were found in the infection group(100%,4/4),and severe anemia,mental disorders and critical renal impairment were found in the co-infection group. The percentage of moderate to severe liver damage and jaundice was83.33% in the 6 cases of co-infection group,and the percentage of renal insufficiency was 50.00%. The test results of Plasmodium falciparum showed that 3 cases of rings and 3 cases of small trophozoites in the co-infected group;1 case of rings and 3 cases of small trophozoites in the infected group. One case in the mono-infected group and two cases in the coinfected group were associated with imaging changes. Conclusions In patients with falciparum malaria complicated with SARS-CoV-2 infection,in addition to febrile changes and liver function damage,cough,anemia,mental disorders and renal function damage also occurred. Laboratory data showed an increase in the percentage of lymphocytes,aggravated liver function damage,and a significant increase in the density of malaria parasites. Imaging changes consistent with COVID-19.Combining changes in clinical manifestations with early screenin

关 键 词：恶性疟疾 输入性 新型冠状病毒肺炎 临床特征 

分 类 号：R531.3[医药卫生—内科学] R511[医药卫生—临床医学]