1例输入性恶性疟死亡病例分析  

Analysis of a case of imported malignant malaria death

作　　者：徐文秀 陈芳[1] 刘聪[1] 罗华堂[1] 杨燕[1] XU Wenxiu;CHEN Fang;LIU Cong;LUO Huatang;YANG Yan(Wuhan Center for Disease Control and Prevention,Wuhan,Hubei 430022,China)

机构地区：[1]武汉市疾病预防控制中心,湖北武汉430022

出　　处：《中国热带医学》2024年第7期889-892,共4页China Tropical Medicine

摘　　要：分析武汉市2024年1例输入性恶性疟的死亡原因以及青蒿素耐药情况,积累重症疟疾病例的救治经验,减少或避免重症病例的发生和死亡。收集患者的流行病学资料、个案调查表、临床诊疗资料、实验室检验结果并进行分析。该病例曾在非洲刚果金从事瓦工工作约9个月,回国后第8天发病,既往无疟疾病史。该病例初诊就诊于私人诊所,且存在误诊,6 d后病情严重遂入院。入院后8 h确诊为恶性疟,立即给与抗疟治疗以及对症支持治疗,用青蒿琥酯注射剂治疗12 h、24 h、48 h分别经血涂片(厚、薄血膜)镜检发现疟原虫密度分别为3.2×10^(5)/μL、3.1×10^(5)/μL、3.1×10^(5)/μL,相较用药前疟原虫密度无明显数量级变化,疟原虫计数略微上升,考虑存在青蒿素耐药可能。患者于确诊后第3天因病情危重1月11日18时30分死于多器官功能衰竭。本例病例初诊就诊于私人诊所,且存在误诊,病例发病到确诊间隔时间超过5 d,导致病人失去了最佳救治时间,同时,该患者感染的疟原虫可能存在青蒿素耐药性,最终导致该病例死亡的发生。To analyze the cause of death and artemisinin resistance of an imported malignant malaria case in Wuhan City in 2024,with the aim of accumulating experience in the treatment of severe malaria cases and reduce or avoid the occurrence of severe cases and deaths.Epidemiological data,case investigation forms,clinical diagnosis and treatment data,and laboratory test results of patients were collected and analyzed.The patient,who had worked as a bricklayer in the Democratic Republic of Congo for about 9 months,became ill on the eighth day after returning to China,with no history of malaria.The initial diagnosis of the case was at a private clinic,and there was a misdiagnosis.After 6 days,the condition became severe and the patient was admitted to the hospital.Approximately 8 hours after admission,the patient was diagnosed with malignant malaria and immediately received anti-malarial treatment and symptomatic supportive treatment.Treatment with artesunate injection for 12,24,and 48 hours showed the density of malaria parasites densities of 3.2×10^(5)/μL,3.1×10^(5)/μL,and 3.1×10^(5)/μL,respectively.There was no significant order of magnitude change in the density of malaria parasites compared to before medication,and the count of malaria parasites slightly increased,suggesting the possibility of artemisinin resistance.The patient died of multiple organ failure at 18:30 on January 11,three days after diagnosis.The initial diagnosis occurred in a private clinic where the patient was misdiagnosed.The interval between the onset of the disease and diagnosis was more than 5 d,which resulted in the loss of optimal time for the patient′s treatment.At the same time,the malaria parasite-infected by the patient may have artemisinin resistance,which ultimately led to the occurrence of the patient′s death.

关 键 词：恶性疟 死亡病例 青蒿素耐药 

分 类 号：R531.3[医药卫生—内科学]