Magill Alan J
Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA.
Curr Infect Dis Rep. 2006 Jan;8(1):35-42. doi: 10.1007/s11908-006-0033-5.
Plasmodium falciparum is responsible for most of the mortality in travelers related to imported malaria. Problems that occur during travel include the inaccuracy of a microscopic diagnosis of malaria, both false positives and false negatives, when ill travelers seek care while abroad. A false positive diagnosis can result in unnecessary parenteral injections that carry a risk of transmission of blood-borne pathogens, receipt of potentially dangerous drugs such as halofantrine, or receipt of fake, counterfeit drugs. Increased morbidity and mortality are associated with delays in diagnosis and initiation of prompt treatment for falciparum malaria. Availability of expert microscopy to confirm the diagnosis of malaria is limited. The presence of splenomegaly and thrombocytopenia are strongly associated with malaria and would justify empiric treatment. The availability of atovaquone-proguanil, a safe and well tolerated oral drug, should prompt a reconsideration of current treatment recommendations that discourage empiric treatment on clinical suspicion alone.
恶性疟原虫是导致与输入性疟疾相关的旅行者死亡的主要原因。旅行期间出现的问题包括，患病旅行者在国外就医时，疟疾的显微镜诊断不准确，存在假阳性和假阴性情况。假阳性诊断可能导致不必要的注射，而注射有传播血源性病原体的风险，还可能导致使用潜在危险药物（如卤泛群）或使用假药、假冒药品。恶性疟的诊断和及时治疗的延误与发病率和死亡率的增加有关。能够确诊疟疾的专业显微镜检查条件有限。脾肿大和血小板减少与疟疾密切相关，有理由进行经验性治疗。青蒿琥酯-乙胺嘧啶作为一种安全且耐受性良好的口服药物，其可及性应促使人们重新考虑目前仅基于临床怀疑就不鼓励经验性治疗的建议。
