Khan M A, Mekan S F, Abbas Z, Smego R A
Department of Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
Singapore Med J. 2005 Nov;46(11):635-8.
The precise incidence of concurrent malaria and enteric fever in most geographical areas is largely unknown, and no data on such an association exists in Asia. Because both malaria and enteric fever are hyperendemic in Pakistan, we sought to determine the frequency, epidemiology, and clinical and laboratory features of dual malaria and enteric fever in a tertiary care setting.
We conducted a retrospective case-control study of 1,891 patients hospitalised with malaria over a ten-year period and identified 21 patients with concurrent culture-proven enteric fever.
Cases with dual infection had significantly more gastrointestinal symptoms at the time of admission, including nausea, vomiting, abdominal pain, and/or diarrhoea compared to matched control subjects with uncomplicated malaria (p-value is less than 0.006). Cases were more likely to have a continuous rather than intermittent fever (p-value is less than 0.0001), delayed defervescence in response to antimalarial treatment (p-value is less than 0.006), normal or low white blood cell counts (p-value is less than 0.04), relatively higher platelet counts among cases versus control (p-value is less than 0.05) and serum haemoglobin (p-value is less than 0.06), elevated alanine aminotransferase levels (p-value is less than 0.02), and a prolonged hospital stay (p-value is less than 0.03). The negative predictive values for gastrointestinal symptoms, continuous fever pattern and delayed defervescence were 80 percent, 72 percent and 74 percent, respectively.
Patients with malaria who have marked gastrointestinal symptoms, continuous pattern of fever and persistence of fever for more than 24 hours after appropriate antimalarial therapy, should be investigated or empirically treated for concurrent enteric fever. The absence of the above clinical features in patients with uncomplicated malaria should reassure physicians that there is no concurrent typhoid fever.
大多数地理区域中疟疾与肠热病并发的确切发病率很大程度上未知，亚洲也不存在关于这种关联的数据。由于疟疾和肠热病在巴基斯坦均为高度地方性流行疾病，我们试图在三级医疗环境中确定疟疾与肠热病双重感染的频率、流行病学以及临床和实验室特征。
我们对10年间因疟疾住院的1891例患者进行了一项回顾性病例对照研究，并确定了21例经培养证实并发肠热病的患者。
与单纯患疟疾的匹配对照受试者相比，双重感染的病例在入院时出现明显更多的胃肠道症状，包括恶心、呕吐、腹痛和/或腹泻（p值小于0.006）。病例更有可能出现持续发热而非间歇性发热（p值小于0.0001），对抗疟治疗的退热反应延迟（p值小于0.006），白细胞计数正常或偏低（p值小于0.04），病例组的血小板计数和血清血红蛋白相对高于对照组（p值小于0.05和0.06），丙氨酸转氨酶水平升高（p值小于0.02），且住院时间延长（p值小于0.03）。胃肠道症状、持续发热模式和退热延迟的阴性预测值分别为80%、72%和74%。
出现明显胃肠道症状、持续发热模式且在适当抗疟治疗后发热持续超过24小时的疟疾患者，应接受并发肠热病的检查或经验性治疗。单纯患疟疾的患者若不存在上述临床特征，医生应放心其没有并发伤寒热。
