Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
Blood. 2010 Jan 14;115(2):215-20. doi: 10.1182/blood-2009-07-233528. Epub 2009 Nov 9.
Approximately 280,000 children are born with sickle cell anemia (SCA) in Africa annually, yet few survive beyond childhood. Falciparum malaria is considered a significant cause of this mortality. We conducted a 5-year prospective surveillance study for malaria parasitemia, clinical malaria, and severe malarial anemia (SMA) in Dar-es-Salaam, Tanzania, between 2004 and 2009. We recorded 10,491 visits to the outpatient clinic among 1808 patients with SCA and 773 visits among 679 patients without SCA. Similarly, we recorded 691 hospital admissions among 497 patients with SCA and 2017 in patients without SCA. Overall, the prevalence of parasitemia was lower in patients with SCA than in patients without SCA both at clinic (0.7% vs 1.6%; OR, 0.53; 95% CI, 0.32-0.86; P = .008) and during hospitalization (3.0% vs 5.6%; OR, 0.46; 95% CI, 0.25-0.94; P = .01). Furthermore, patients with SCA had higher rates of malaria during hospitalization than at clinic, the ORs being 4.29 (95% CI, 2.63-7.01; P < .001) for parasitemia, 17.66 (95% CI, 5.92-52.71; P < .001) for clinical malaria, and 21.11 (95% CI, 8.46-52.67; P < .001) for SMA. Although malaria was rare among patients with SCA, parasitemia during hospitalization was associated with both severe anemia and death. Effective treatment for malaria during severe illness episodes and further studies to determine the role chemoprophylaxis are required.
在非洲，每年约有 28 万名儿童患有镰状细胞性贫血症（SCA），但很少有患者能活过儿童期。恶性疟原虫感染被认为是导致这种死亡率的一个重要原因。我们在 2004 年至 2009 年期间，在坦桑尼亚的达累斯萨拉姆进行了一项为期 5 年的镰状细胞性贫血症患者疟疾寄生虫血症、临床疟疾和严重疟疾性贫血症（SMA）的前瞻性监测研究。我们记录了 1808 名镰状细胞性贫血症患者中有 10491 次门诊就诊记录，679 名非镰状细胞性贫血症患者中有 773 次就诊记录。同样，我们记录了 497 名镰状细胞性贫血症患者中有 691 次住院治疗记录，而 2017 次是在非镰状细胞性贫血症患者中。总体而言，在诊所（0.7%比 1.6%；比值比，0.53；95%置信区间，0.32-0.86；P =.008）和住院期间（3.0%比 5.6%；比值比，0.46；95%置信区间，0.25-0.94；P =.01），镰状细胞性贫血症患者寄生虫血症的发生率均低于非镰状细胞性贫血症患者。此外，镰状细胞性贫血症患者住院期间疟疾的发生率高于诊所，比值比分别为寄生虫血症 4.29（95%置信区间，2.63-7.01；P <.001）、临床疟疾 17.66（95%置信区间，5.92-52.71；P <.001）和 SMA 21.11（95%置信区间，8.46-52.67；P <.001）。尽管镰状细胞性贫血症患者中疟疾很少见，但住院期间的寄生虫血症与严重贫血和死亡均相关。需要对镰状细胞性贫血症患者严重疾病发作期间的疟疾进行有效治疗，并进一步研究化学预防的作用。
