Myrvang B
Infeksjonsmedisinsk avdeling Ullevål sykehus, Oslo.
Tidsskr Nor Laegeforen. 2000 May 30;120(14):1648-52.
The paper describes and discusses procedures and problems related to diagnostics, therapy and prophylaxis of malaria in Norway. A high degree of suspicion in physicians evaluating febrile travellers is of the utmost importance. The clinical symptoms and findings are initially rather unspecific, with fever and fever related symptoms. A definite diagnosis is made by the demonstration of malaria parasites in thin and thick blood smears, which is best performed by an infectious disease physician. Before treatment is started, it is important to determine whether the patient is infected with Plasmodium falciparum or with one of the more benign malaria species. If this is difficult microscopically, a test that detects P. falciparum antigen in blood may be useful in some cases. The therapy of benign malaria is still chloroquine plus primaquine; most patients with malaria falciparum can be routinely treated with mefloquine. Cases of complicated falciparum malaria, usually due to delayed diagnosis and start of treatment, require extensive and sophisticated treatment, usually including parenteral treatment with quinine. Prophylaxis consists of prevention of mosquito bites and chemoprophylaxis; the importance of avoiding bites should never be underestimated. A more widespread use of mefloquine among travellers to Africa is the most important change in chemoprophylaxis in recent years. Finally the article discusses possible improvements in diagnostic procedure, therapy and chemoprophylaxis.
本文描述并讨论了挪威疟疾诊断、治疗和预防方面的程序及问题。医生在评估发热的旅行者时保持高度怀疑至关重要。临床症状和体征最初相当不具特异性，表现为发热及与发热相关的症状。通过在薄血涂片和厚血涂片中发现疟原虫来做出明确诊断，这最好由传染病医生进行。在开始治疗前，确定患者感染的是恶性疟原虫还是其他较温和的疟原虫种类很重要。如果在显微镜下难以判断，检测血液中恶性疟原虫抗原的试验在某些情况下可能有用。良性疟疾的治疗仍然是氯喹加伯氨喹；大多数恶性疟患者通常可用甲氟喹常规治疗。复杂的恶性疟病例，通常由于诊断和治疗延迟，需要广泛而复杂的治疗，通常包括用奎宁进行胃肠外治疗。预防包括防止蚊虫叮咬和化学预防；绝不应低估避免被叮咬的重要性。近年来，在前往非洲的旅行者中更广泛地使用甲氟喹是化学预防方面最重要的变化。最后，本文讨论了诊断程序、治疗和化学预防方面可能的改进。
