D'Acremont Valérie, Landry Pierre, Mueller Ivo, Pécoud Alain, Genton Blaise
Travel Clinic, University of Lausanne, Switzerland.
Am J Trop Med Hyg. 2002 May;66(5):481-6. doi: 10.4269/ajtmh.2002.66.481.
No evidence-based information exists to guide clinicians for giving presumptive treatment to returning travelers when malaria is strongly suspected on clinical grounds but laboratory confirmation is not immediately available or is negative. A prospective study was conducted in travelers or migrants who sought care for fever to identify clinical and laboratory predictors of Plasmodium parasitemia. A total of 336 questionnaires were collected (97 malaria case patients and 239 controls). Multivariate regression analysis showed inadequate prophylaxis, sweating, no abdominal pain, temperature > or = 38 degrees C, poor general health, enlarged spleen, leucocytes < or = 10 x 10(3)/L, platelets < 150 x 10(3)/L, hemoglobin < 12 g/dL, and eosinophils < or = 5% to be associated with parasitemia. Enlarged spleen had the highest positive likelihood ratio for a diagnosis of malaria (13.6), followed by thrombopenia (11.0). Posttest probabilities for malaria were 85% with enlarged spleen and 82% with thrombopenia. A rapid assessment can thus help to decide whether a presumptive treatment should be given or not, especially when the results of the parasitological examination are not immediately available or are uncertain.
当根据临床症状高度怀疑疟疾，但无法立即获得实验室确诊结果或实验室检查结果为阴性时，目前尚无循证医学信息可指导临床医生对归国旅行者进行经验性治疗。本研究对因发热就诊的旅行者或移民进行了一项前瞻性研究，以确定疟原虫血症的临床和实验室预测指标。共收集了336份问卷（97例疟疾病例患者和239例对照）。多因素回归分析显示，预防措施不当、出汗、无腹痛、体温≥38℃、总体健康状况差、脾脏肿大、白细胞≤10×10³/L、血小板＜150×10³/L、血红蛋白＜12g/dL以及嗜酸性粒细胞≤5%与疟原虫血症相关。脾脏肿大对疟疾诊断的阳性似然比最高（13.6），其次是血小板减少（11.0）。脾脏肿大时疟疾的验后概率为85%，血小板减少时为82%。因此，快速评估有助于决定是否应进行经验性治疗，尤其是在寄生虫学检查结果无法立即获得或不确定时。
