Bach Olaf, Baier Michael, Pullwitt Annika, Fosiko Nedson, Chagaluka George, Kalima Matthew, Pfister Wolfgang, Straube Eberhard, Molyneux Malcolm
Faculty of Medicine, Department of Trauma Hand and Reconstructive Surgery, University of Jena, 07740 Jena, Germany.
Trans R Soc Trop Med Hyg. 2005 Nov;99(11):861-7. doi: 10.1016/j.trstmh.2005.03.008.
We identified 33 Malawians who had undergone total splenectomy for traumatic injury. We reviewed these and 33 controls by clinical and parasitological examination monthly for 1 year. Splenectomized patients (S) were 2.5 times as likely as controls (C) to complain about febrile symptoms during the month preceding a visit (P < 0.0001). They were nearly twice as likely as controls to have Plasmodium falciparum parasitaemia (S: 176/283 person visits; C: 86/262; P < 0.0001). Parasitaemia was more likely to be associated with febrile symptoms in splenectomized individuals (S: 104/176, 59%; C: 24/86, 28%; P < 0.0001). There were three deaths (two non-malarial, one unexplained) among splenectomized subjects and none in the control group. Parasite densities reached significantly higher levels, and mature parasite stages were more often seen in the peripheral blood, in asplenic individuals. In a partially immune population, asplenic individuals are at increased risk of malarial infections and illness. In a larger group without the benefit of regular review and prompt therapy, there may be an increased risk of life-threatening malaria. Splenectomy should be avoided when possible in an area with endemic transmission of P. falciparum.
我们确定了33名因创伤性损伤而接受全脾切除术的马拉维人。我们对这些患者和33名对照者进行了为期1年的每月临床和寄生虫学检查。在就诊前一个月，脾切除患者（S）出现发热症状的可能性是对照者（C）的2.5倍（P<0.0001）。他们感染恶性疟原虫血症的可能性几乎是对照者的两倍（S组：283人次中有176人次；C组：262人次中有86人次；P<0.0001）。在脾切除个体中，寄生虫血症更有可能与发热症状相关（S组：176例中有104例，59%；C组：86例中有24例，28%；P<0.0001）。脾切除受检者中有3人死亡（2例非疟疾死亡，1例死因不明），对照组无死亡病例。在无脾个体中，寄生虫密度达到显著更高水平，且外周血中更常出现成熟寄生虫阶段。在部分免疫人群中，无脾个体感染疟疾和患病的风险增加。在一个没有定期复查和及时治疗的更大群体中，可能存在危及生命的疟疾风险增加的情况。在恶性疟原虫地方性传播的地区，应尽可能避免进行脾切除术。
