Alvarez Fernández B, García Esteban C, Soto Insuga V, Ruiz Jiménez M, Rubio Gribble B, Jiménez Fernández F, Ramos Amador J T
Servicio de Pediatría, Hospital Universitario, Getafe, Madrid, España.
An Pediatr (Barc). 2009 Sep;71(3):196-200. doi: 10.1016/j.anpedi.2009.05.016. Epub 2009 Jul 19.
Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital.
A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out.
Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01). Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%.
The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis.
疟疾在西班牙的发病率有所上升，且在儿童中可能较为严重。西班牙关于儿童疟疾的信息匮乏。本研究旨在评估我院确诊为疟疾的儿童的临床、治疗及流行病学特征。
对1995年1月至2006年11月在赫塔费大学医院确诊的所有儿童疟疾病例进行回顾性描述性研究。研究了流行病学和临床特征，以及诊断方法、治疗和预后情况。对两个比较时期（2000年1月前后）进行了分析。
共确诊18例疟疾病例，其中12例为女孩，6例为男孩。年龄范围为13个月至13岁，中位年龄为60个月。所有患者近期都有往返疟疾流行国家的旅行史。尽管随着时间推移住院人数稳定，但除2例患者外，其余均在第二个时期被诊断出（P<0.01）。发热和胃肠道症状是最常见的症状，75%的患者有肝脏或脾脏肿大。血小板减少和贫血很常见。未发生复杂疟疾或死亡病例。所有病例均采用显微镜检查进行疟原虫鉴定。16名儿童采用聚合酶链反应（PCR）进行疟原虫种类鉴定。其中89%的病例发现恶性疟原虫。72%的患者使用了硫酸奎宁和克林霉素。
马德里南部地区儿童疟疾发病率正在上升，恶性疟原虫是最常见的鉴定种类。显微镜观察或其抗原鉴定是金标准诊断方法，然而，入院时采用PCR鉴定对于确定种类和排除可能的多重感染至关重要。儿科医生必须学会怀疑这种潜在的严重疾病，以便尽早进行治疗，改善预后。
