Gachot B, Bruneel F, Behr C
Service de pathologie infectieuse et tropicale Centre médical de l'Institut Pasteur 75724 Paris.
Rev Prat. 2001 Mar 31;51(6):638-43.
Falciparum malaria remains a major killer in developing countries, particularly for African children. Moreover, France is the leading European country in term of incidence of imported malaria. Parasitized erythrocytes, which can form rosettes or auto-agglutinate, are sequestrated in the deep microvasculature and stick to activated endothelium by the mean of various receptors. Activation of T lymphocytes and macrophages induces secretion of proinflammatory cytokines, including tumour necrosis factor, which contributes to severe disease. However, the pathophysiology of coma remains poorly understood. In nonimmune adults, besides cerebral malaria, pictures of severe sepsis with shock, acute renal failure and respiratory distress syndrome are common. Although chemotherapy of malaria is challenged by the continuing evolution of antimalarial resistance, quinine remains the first-line drug for severe imported disease. In addition, early symptomatic management in the intensive care unit setting is of paramount importance. Prevention of severe imported malaria lays on prophylactic measures during travel, as well as adequate management of uncomplicated disease after return. In developing countries, early and adequate treatment of uncomplicated disease using cheap alternatives to classical compounds should contribute to "roll back" malaria, particularly in sub-Saharan Africa.
恶性疟疾仍然是发展中国家的主要杀手，对非洲儿童而言尤为如此。此外，就输入性疟疾的发病率而言，法国是欧洲主要国家。被寄生的红细胞可形成玫瑰花结或自身凝集，被隔离在深部微血管中，并通过各种受体黏附于活化的内皮细胞。T淋巴细胞和巨噬细胞的激活会诱导促炎细胞因子的分泌，包括肿瘤坏死因子，这会导致严重疾病。然而，昏迷的病理生理学仍知之甚少。在非免疫的成年人中，除了脑型疟疾外，伴有休克、急性肾衰竭和呼吸窘迫综合征的严重脓毒症表现也很常见。尽管疟疾化疗因抗疟耐药性的不断演变而面临挑战，但奎宁仍然是严重输入性疾病的一线药物。此外，在重症监护病房进行早期症状管理至关重要。预防严重输入性疟疾依赖于旅行期间的预防措施，以及回国后对非复杂性疾病的适当管理。在发展中国家，使用经典化合物的廉价替代品对非复杂性疾病进行早期和充分治疗应有助于“遏制”疟疾，特别是在撒哈拉以南非洲地区。
