Thierfelder Clara, Schill Catherine, Hatz Christoph, Nüesch Reto
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
J Travel Med. 2008 Nov-Dec;15(6):432-6. doi: 10.1111/j.1708-8305.2008.00251.x.
Due to persistent international travel and immigration trends, imported malaria remains to be of clinical and public health importance in nonendemic countries. The aim of this study was to investigate trends in imported malaria over a period of more than three decades.
We assessed travel history, demographic characteristics, and clinical course with special regard to malaria diagnosis and intensive care unit (ICU) admission of patients diagnosed with malaria. The sample comprised 109 patients with the diagnosis of malaria according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-coding system (versions 9 and 10) at the University Hospital and at a teaching hospital in Basel between January 1994 and June 2004. Changes in clinical management and outcomes were compared with previous studies at the same institutions dating back to the 1970s.
The most common reason for travel was to visit friends and relatives in the country of origin (37%), and most infections were acquired in Africa (82%), with Plasmodium falciparum malaria the most frequently found parasite (84%). The mean time between first symptoms and the diagnosis of malaria was 4 days (range 0.5-31 d). Delay in diagnosis occurred in 14% of cases, and 37% of hospitalized patients were referred to the ICU. In 22% of referred cases, high parasitemia (>2%) according to internal criteria was a reason for referral. The course of disease remained mild in the great majority (90%) of patients, and none of the patients died.
Prompt and specific diagnosis of malaria could be improved. Malaria-associated mortality was reduced over time. As ICU referral showed to be inappropriately high in relation to a moderate clinical course of several admitted patients, criteria for ICU admission should be reevaluated. The trend toward malaria in patients originating from endemic areas suggests that preventive travel advice should specifically address these patients.
由于持续的国际旅行和移民趋势，输入性疟疾在非流行国家仍然具有临床和公共卫生重要性。本研究的目的是调查三十多年来输入性疟疾的趋势。
我们评估了旅行史、人口统计学特征以及临床病程，特别关注疟疾诊断和确诊疟疾患者的重症监护病房（ICU）收治情况。样本包括1994年1月至2004年6月期间在巴塞尔大学医院和一家教学医院根据国际疾病和相关健康问题统计分类（ICD）编码系统（第9版和第10版）诊断为疟疾的109例患者。将临床管理和结局的变化与同一机构可追溯到20世纪70年代的先前研究进行比较。
最常见的旅行原因是探望原籍国的朋友和亲戚（37%），大多数感染发生在非洲（82%），恶性疟原虫疟疾是最常见的寄生虫（84%）。首次出现症状至疟疾诊断的平均时间为4天（范围0.5 - 31天）。14%的病例出现诊断延迟，37%的住院患者被转诊至ICU。在22%的转诊病例中，根据内部标准高寄生虫血症（>2%）是转诊的原因。绝大多数患者（90%）的病程仍然较轻，没有患者死亡。
疟疾的及时和特异性诊断有待改善。随着时间的推移，疟疾相关死亡率有所降低。由于相对于几名入院患者的中度临床病程，ICU转诊显示过高，应重新评估ICU收治标准。来自流行地区患者中疟疾的趋势表明，预防性旅行建议应特别针对这些患者。
