Singhal Tanu
PD Hinduja National Hospital and Research Centre, Mumbai, India.
Indian J Pediatr. 2004 Jan;71(1):81-8. doi: 10.1007/BF02725663.
Prompt diagnosis and early institution of therapy is an important determinant of outcome in severe falciparum malaria. Thick smears are the gold standard for diagnosis; in situations where reliable microscopy is not available, tests based on HRP-2 antigen/parasite LDH are useful. As there is widespread resistance to chloroquine in P falciparum in India, the choice for specific antimalarial therapy is between quinine and artermisinin derivatives. Randomized controlled trials have not revealed any significant benefit of the artemisinin derivatives over quinine in quinine sensitive areas. Also, if quinine is administered in the recommended way, the side effects are no greater than artemisinins. However, as the artemisinin derivatives are easier to administer, their use in severe malaria in India is increasing. It is vital that we use these drugs in a rational and judicious manner to prevent development of drug resistance. Supportive care, early diagnosis and management of complications are as essential as antimalarial therapy. The role of exchange blood transfusion in the management of severe malaria is still controversial. It may be considered in the presence of high parasites counts (>10%) with multiorgan dysfunction if adequate quantities of safe blood are available.
及时诊断并尽早开始治疗是重症恶性疟预后的重要决定因素。厚涂片是诊断的金标准；在无法进行可靠显微镜检查的情况下，基于HRP - 2抗原/寄生虫乳酸脱氢酶的检测很有用。由于印度恶性疟原虫对氯喹普遍耐药，特定抗疟治疗的选择在奎宁和青蒿素衍生物之间。随机对照试验未显示在对奎宁敏感的地区，青蒿素衍生物比奎宁有任何显著优势。而且，如果以推荐方式使用奎宁，其副作用并不比青蒿素更大。然而，由于青蒿素衍生物更易于给药，它们在印度重症疟疾中的使用正在增加。我们必须合理、明智地使用这些药物以防止耐药性的产生。支持性治疗、并发症的早期诊断和处理与抗疟治疗同样重要。换血疗法在重症疟疾治疗中的作用仍存在争议。如果有足够数量的安全血液，在寄生虫计数高（>10%）且伴有多器官功能障碍的情况下可考虑采用。
