Charra B, Sodqi M, Sandali O, Nejmi H, Hachimi A, Ezzouine H, Benslama A, Himmich H, Motaouakkil S
Service de Réanimation Médicale, CHU Ibn-Rochd Casablanca, Maroc.
Med Mal Infect. 2007 Mar;37(3):162-5. doi: 10.1016/j.medmal.2006.09.006. Epub 2007 Jan 2.
We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital.
All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated.
Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died.
The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.
我们报告了在卡萨布兰卡伊本-鲁西德大学医院医学重症监护病房进行的一项回顾性研究。
纳入1996年至2001年间入住重症监护病房的所有14岁以上的恶性疟患者。调查了主要的流行病学特征、入院标准、治疗方法及结果。
纳入10例严重输入性疟疾患者。平均年龄为32±4岁。所有患者均在撒哈拉以南非洲感染恶性疟。所有患者的化学预防均不充分。从症状出现到开始治疗的平均时间为9±2天。入院标准为意识障碍（7例）、急性肾衰竭（4例）和呼吸窘迫（3例）。最令人担忧的因素是意识障碍的严重程度、急性呼吸窘迫综合征、代谢性酸中毒和难治性休克。所有患者在病程中均出现与革兰氏阴性杆菌相关的医院获得性呼吸道感染。所有患者均接受了负荷剂量的奎宁治疗及对症治疗。5例患者死亡。
尽管在重症监护病房进行了最佳管理，但严重输入性疟疾的致死率仍然很高。改善化学预防和早期诊断可能会显著降低死亡率。
