Sandhu Gagangeet, Ranade Aditi, Ramsinghani Prakash, Noel Camille
Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
J Emerg Med. 2011 Jul;41(1):35-8. doi: 10.1016/j.jemermed.2010.02.032. Epub 2010 Apr 24.
According to the Centers for Disease Control and Prevention, the risk of fatal malaria in non-endemic countries can be reduced greatly if physicians are alert to the atypical presenting features of malaria.
A patient arrived in the United States from Nigeria 2 days before presenting to an emergency department (ED) with sore throat, dry cough, fever (without chills), headache, and severe lethargy. A presumptive diagnosis of influenza-like illness was made. The patient improved after symptomatic treatment and was therefore discharged from the ED; she continued with her travel. After 24 h, the patient presented to our ED with symptoms suggestive of meningitis. The analysis of the cerebrospinal fluid was normal. A peripheral blood smear was diagnostic of falciparum malaria (parasitic index of 1). Because the disease was acquired from a chloroquine-resistant endemic area, the patient was treated with quinine and doxycycline, and she responded well.
In this era of heightened influenza alert, differentiating between influenza-like illness and malaria can be challenging. Patients with a history of travel to a malaria-endemic area in the preceding year should undergo a complete blood count (CBC), hepatic panel, and blood smear. Due to logistic reasons, the result of a blood smear may not be available immediately. Thrombocytopenia and hyperbilirubinemia each has a positive predictive value of 95% in the presumptive diagnosis of malaria. Patients who do not appear sick, and those who have a normal CBC and hepatic panel, may be treated symptomatically and discharged (with follow-up advised). Those with a presumptive diagnosis of malaria or unclear speciation should be admitted for anti-malarial therapy.
根据美国疾病控制与预防中心的数据，如果医生能警惕疟疾的非典型表现特征，非疟疾流行国家的致命疟疾风险可大幅降低。
一名患者从尼日利亚抵达美国，两天后因咽痛、干咳、发热（无寒战）、头痛和严重嗜睡前往急诊科就诊。初步诊断为流感样疾病。患者经对症治疗后病情好转，因此从急诊科出院；她继续旅行。24小时后，该患者因疑似脑膜炎症状再次来到我们的急诊科。脑脊液分析结果正常。外周血涂片诊断为恶性疟（疟原虫指数为1）。由于该疾病来自氯喹耐药流行区，患者接受了奎宁和强力霉素治疗，反应良好。
在当前流感警戒级别提高的时代，区分流感样疾病和疟疾可能具有挑战性。有前一年前往疟疾流行区旅行史的患者应进行全血细胞计数（CBC）、肝功能检查和血涂片检查。由于后勤原因，血涂片结果可能无法立即获得。血小板减少症和高胆红素血症在疟疾的初步诊断中各自具有95%的阳性预测价值。看起来没有生病且全血细胞计数和肝功能检查正常的患者可进行对症治疗并出院（建议进行随访）。初步诊断为疟疾或虫种不明确的患者应住院接受抗疟治疗。
