Badiaga Sékéné, Barrau Karine, Parola Philippe, Brouqui Philippe, Delmont Jean
Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Marseille, France.
J Travel Med. 2002 May-Jun;9(3):117-21. doi: 10.2310/7060.2002.23842.
The gold standard in diagnosis of malaria is microscopic detection of malaria parasites in thin blood smears. However, the sensitivity and specificity of blood smears depend mostly on the experience of the examiner. In the traveler returning from the tropics, diagnosis of malaria may be difficult when the parasitemia is low. In this circumstance any indicator that suggests the diagnosis of malaria is of great interest. The aim of this study is to determine the value of hypocholesterolemia to the diagnosis of imported malaria.
A retrospective case-control study was performed among hospitalized patients with fever returning from a malaria-endemic area, to compare the results of routine biological parameters of 129 malaria cases with those of 92 control patients.
Multivariate analysis, using a logistic regression model demonstrates that hypocholesterolemia was the strongest parameter associated with malaria (adjusted odds ratio [OR]: 75.22, 95% confidence interval [CI] 4.60-1227.78) and the most specific (98%, 95% CI 0.95-1.0). The most sensitive abnormality was thrombocytopenia (82%, 95% CI-0.77 0.87). With a malaria prevalence of 52% in our population study, hypocholesterolemia has the strongest positive predictive value among routine biological parameters for malaria diagnosis (96%). The combination of hypocholesterolemia and thrombocytopenia was always associated with diagnosis of malaria in this study.
These results show that hypocholesterolemia is significantly associated with malaria. Therefore, in the setting of negative thin and thick blood smears, the presence of hypocholesterolemia, particularly when it is combined with thrombocytopenia, in a febrile traveler returning from a malaria-endemic area, should prompt repetition and careful analysis of blood smears to avoid misdiagnosis.
疟疾诊断的金标准是在薄血涂片上显微镜检测疟原虫。然而，血涂片的敏感性和特异性主要取决于检查者的经验。对于从热带地区归来的旅行者，当疟原虫血症较低时，疟疾的诊断可能会很困难。在这种情况下，任何提示疟疾诊断的指标都备受关注。本研究的目的是确定低胆固醇血症对输入性疟疾诊断的价值。
对从疟疾流行地区归来且发热的住院患者进行回顾性病例对照研究，比较129例疟疾病例与92例对照患者的常规生物学参数结果。
使用逻辑回归模型进行多变量分析表明，低胆固醇血症是与疟疾相关的最强参数（调整比值比[OR]：75.22，95%置信区间[CI] 4.60 - 1227.78）且最具特异性（98%，95% CI 0.95 - 1.0）。最敏感的异常是血小板减少（82%，95% CI - 0.77 0.87）。在我们的人群研究中疟疾患病率为52%，低胆固醇血症在疟疾诊断的常规生物学参数中具有最强的阳性预测值（96%）。在本研究中，低胆固醇血症和血小板减少的组合总是与疟疾诊断相关。
这些结果表明低胆固醇血症与疟疾显著相关。因此，在薄血涂片和厚血涂片结果均为阴性的情况下，对于从疟疾流行地区归来的发热旅行者，若存在低胆固醇血症，尤其是当其与血小板减少同时出现时，应促使重复并仔细分析血涂片以避免误诊。
