Dorsey G, Gandhi M, Oyugi J H, Rosenthal P J
Box 0811, Department of Medicine, University of California, San Francisco, CA 94143, USA.
Arch Intern Med. 2000 Sep 11;160(16):2505-10. doi: 10.1001/archinte.160.16.2505.
Imported malaria is quite common in the United States. Increasing antimalarial drug resistance and changes in travel patterns may have important implications for the prevention, clinical presentation, and management of this disease.
Medical records were reviewed for 121 patients with microscopically confirmed malaria diagnosed at 2 university-affiliated hospitals in San Francisco, Calif, between 1988 and 1997.
Among 57 travelers from the United States, only 13 (23%) had been compliant with an appropriate chemoprophylactic regimen. No patients developed falciparum malaria after consistent chemoprophylactic therapy with mefloquine hydrochloride. However, 12 (19%) of US residents with imported malaria developed Plasmodium vivax or Plasmodium ovale infections despite an appropriate chemoprophylactic regimen, generally with a late onset suggestive of relapsing disease. Clinical presentations were similar between foreign residents and American travelers and between patients with falciparum and nonfalciparum infections; 98% of patients had a history of fever. Sixteen percent of patients had received previous evaluations during which the diagnosis of malaria was not considered. In 9% of patients, there were errors in treatment. Only 1 patient developed severe malaria.
Our results suggest that a standard chemoprophylactic regimen is highly effective in preventing falciparum malaria, but that many American travelers do not receive it. Also, relapsing P vivax or P ovale infection despite appropriate chemoprophylactic therapy was not uncommon among our cases. The presentation of imported malaria is nonspecific, highlighting the need to consider the diagnosis in any febrile patient who has been in a malaria-endemic area. Although errors in diagnosis and treatment were quite common in our study population, patient outcomes were good once the appropriate therapy was initiated.
输入性疟疾在美国颇为常见。抗疟药物耐药性的增加以及旅行模式的变化可能对该疾病的预防、临床表现及管理产生重要影响。
回顾了1988年至1997年间在加利福尼亚州旧金山的2家大学附属医院确诊的121例经显微镜检查证实的疟疾患者的病历。
在57名来自美国的旅行者中，只有13名（23%）遵守了适当的化学预防方案。在接受盐酸甲氟喹持续化学预防治疗后，没有患者发生恶性疟。然而，12名（19%）输入性疟疾的美国居民尽管采用了适当的化学预防方案，仍感染了间日疟原虫或卵形疟原虫，通常发病较晚，提示为复发性疾病。外国居民与美国旅行者之间以及恶性疟与非恶性疟感染患者之间的临床表现相似；98%的患者有发热史。16%的患者此前曾接受评估，但当时未考虑疟疾诊断。9%的患者存在治疗错误。只有1名患者发生了重症疟疾。
我们的结果表明，标准的化学预防方案在预防恶性疟方面非常有效，但许多美国旅行者未接受该方案。此外，在我们的病例中，尽管采用了适当的化学预防治疗，间日疟原虫或卵形疟原虫复发性感染并不罕见。输入性疟疾的表现不具特异性，这凸显了对任何去过疟疾流行地区的发热患者都需考虑疟疾诊断的必要性。尽管在我们的研究人群中诊断和治疗错误相当常见，但一旦开始适当治疗，患者的预后良好。
