Koh K H, Chew P H, Kiyu A
Medical Department, Sarawak General Hospital, 30 Lorong Sky Garden 2, Off Green Road, 93150 Kuching, Malaysia.
Singapore Med J. 2004 Jan;45(1):28-36.
To study the clinical and demographic aspects as well as the outcomes of severe cases of malaria infections managed in the intensive care unit of the Sarawak General Hospital, Kuching from January 1996 to December 2001.
All cases of malaria admitted to the intensive care unit of the Sarawak General Hospital from January 1996 to December 2001 were identified from the intensive care records and retrospectively reviewed.
A total of 31 cases of malaria were managed in the intensive care unit of the Sarawak General Hospital in the six-year period. Twenty-eight cases were P. falciparum infections; two were P. vivax and one was a mixed infection of P. falciparum and P. vivax. Fever with or without chills and rigors, headache, abdominal pain and vomiting were the four commonest presenting complaints for P. falciparum infections. Patients with both abdominal pain and hepatomegaly have significantly higher mortality. The fatal cases, at presentation, had higher parasite counts, higher bilirubin, aminotransferase, potassium and urea levels, but lower haemoglobin and platelet counts, and more deranged coagulation profiles compared to surviving patients. The major complications include acute renal failure, acute respiratory distress syndrome, cerebral malaria and disseminated intravascular coagulopathy, haemolytic anaemia and liver dysfunction. A single case of vivax malaria, which was complicated by septicaemic shock and disseminated intravascular coagulopathy was also documented. Higher mortality rate was documented if the antimalarial medication was not commenced on the day of admission into hospital.
Several infections of P. falciparum are still associated with significant mortality. Other confounding factors include the patient's own initiating quinine therapy. Aggressive and appropriate therapy is life saving. Earlier anti-malaria treatment may improve the survival rate for falciparum malaria. The isolated case of death from P. vivax infection argues against complacency in the management of even the "benign" form of the infection.
研究1996年1月至2001年12月在古晋砂拉越总医院重症监护病房治疗的重症疟疾感染患者的临床和人口统计学特征以及治疗结果。
从重症监护记录中识别出1996年1月至2001年12月入住砂拉越总医院重症监护病房的所有疟疾病例，并进行回顾性分析。
在六年期间，砂拉越总医院重症监护病房共治疗了31例疟疾病例。其中28例为恶性疟原虫感染；2例为间日疟原虫感染，1例为恶性疟原虫和间日疟原虫混合感染。发热伴或不伴有寒战和 rigor（此处可能有误，应为rigors，寒战）、头痛、腹痛和呕吐是恶性疟原虫感染最常见的四个主诉症状。同时伴有腹痛和肝肿大的患者死亡率显著更高。与存活患者相比，致命病例在就诊时寄生虫计数更高、胆红素、转氨酶、钾和尿素水平更高，但血红蛋白和血小板计数更低，凝血指标更紊乱。主要并发症包括急性肾衰竭、急性呼吸窘迫综合征、脑型疟疾和弥散性血管内凝血、溶血性贫血和肝功能障碍。还记录了1例间日疟并发败血症性休克和弥散性血管内凝血的病例。如果在入院当天未开始抗疟治疗，则死亡率更高。
几种恶性疟原虫感染仍与显著的死亡率相关。其他混杂因素包括患者自行开始使用奎宁治疗。积极且恰当的治疗可挽救生命。早期抗疟治疗可能提高恶性疟的生存率。间日疟感染导致的孤立死亡病例表明，即使是“良性”形式的感染，在管理上也不能掉以轻心。
