Srinivas Rajagopala, Agarwal Ritesh, Gupta Dheeraj
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Malar J. 2007 Apr 12;6:42. doi: 10.1186/1475-2875-6-42.
Co-infection with falciparum malaria and leptospirosis is uncommon. The aim of this study is to report a case of severe sepsis secondary to dual infection with falciparum malaria and leptospirosis. The literature is also reviewed on the clinical course of such co-infections, and the possible mechanisms and treatment of patients with life-threatening malaria and leptospirosis with activated protein C. The patient was a 25-year old male admitted in the Respiratory Intensive Care Unit (RICU) with fever, haemolysis, acute renal failure, hepatitis, acute lung injury (ALI) and altered sensorium. A syndromic evaluation was done and investigations revealed falciparum parasitaemia. He was treated with parenteral artesunate, ceftriaxone and doxycycline, and adjunctive therapies as for severe sepsis. Infusion of activated protein C was started 20 hours after onset of organ dysfunction, and intensive haemodialysis was instituted. Over the next four days the patient became afebrile with progressive resolution of ALI, renal failure and hepatitis. His Leptospira serology (requested as part of the evaluation) was reported positive on day 5. Dual infections are common and under-recognized in the tropics. Failure to treat potential co-infections may lead to poor outcomes. Acute lung injury in falciparum malaria has high mortality rates and therapy as for severe sepsis may improve survival. Adjunctive therapies, including activated protein C, cannot replace source eradication.
恶性疟原虫与钩端螺旋体的合并感染并不常见。本研究旨在报告一例由恶性疟原虫与钩端螺旋体双重感染继发的严重脓毒症病例。同时对这类合并感染的临床病程、危及生命的疟疾和钩端螺旋体病患者使用活化蛋白C的可能机制及治疗方法进行文献综述。该患者为一名25岁男性，因发热、溶血、急性肾衰竭、肝炎、急性肺损伤（ALI）及意识改变入住呼吸重症监护病房（RICU）。进行了综合征评估，检查发现恶性疟原虫血症。给予其静脉注射青蒿琥酯、头孢曲松和多西环素，并采取了针对严重脓毒症的辅助治疗措施。在器官功能障碍发作20小时后开始输注活化蛋白C，并进行强化血液透析。在接下来的四天里，患者体温恢复正常，ALI、肾衰竭和肝炎逐渐好转。其钩端螺旋体血清学检查（作为评估的一部分进行）在第5天报告为阳性。双重感染在热带地区很常见且未得到充分认识。未能治疗潜在的合并感染可能导致不良后果。恶性疟原虫所致急性肺损伤死亡率很高，采用针对严重脓毒症的治疗方法可能会提高生存率。包括活化蛋白C在内的辅助治疗不能替代源头根除。
