Yaméogo T M, Kyelem C G, Ouédraogo S M, Diallo O J, Moyenga L, Poda G E A, Guiguemdé T R
Institut des sciences de la santé, Bobo Dioulasso, Burkina Faso.
Bull Soc Pathol Exot. 2011 Oct;104(4):284-7. doi: 10.1007/s13149-010-0129-x. Epub 2011 Jan 31.
The purpose of this study was to assess the application of national guidelines on the diagnosis and treatment of severe malaria in adults in Burkina Faso. We conducted a retrospective study of medical records of the patients admitted for severe malaria in the emergency service of the regional hospital of Fada N'Gourma in the east of Burkina Faso in the year 2008; 165 records were chosen by simple random sampling. We reported all the severe clinical and biological signs of malaria and its treatment. We compared them with the criteria of severe malaria diagnosis and its treatment according to the national guidelines. The mean age of patients was 38 ± 16.2 and male to female ratio was 0.96. The most frequent period of admissions was between July and October. Fever or recent past of fever was reported in 142 cases (86.1%). According to the two criteria for severe malaria (means existing of at least one of the severe signs associated and positive parasitemia with Falciparum plasmodium), we noted that only 74 cases had at least one of the severe signs (44.8%) which were: anemia (51.3%), cardiovascular collapse (7.9%), jaundice (7.3%), dyspnea (6.7%), impairment of consciousness (5.5%), prostration (5.5%), renal failure (4.8%), hypoglycemia (2.4%), hemorrhage (1.8%) and seizures (1.2%). The biological signs were not systematically searched. Parasitological exam was conducted in 91 cases (55.1%). Only 18 were positive (19.8%). In total, only 18 cases (10.9%) met the guidelines' criteria of severe malaria. The other cases were over-diagnosed; note that the investigation was not complete for 74 of these cases (50.3%). Among the 165 cases, the treatment was appropriate in 146 (88.5%) and 19 cases (11.5%) didn't receive treatment for malaria.
So much we observed an over diagnosis of severe malaria in adults that we can suggest an under diagnosis of the disease due to the lack of biological investigations.
本研究的目的是评估布基纳法索成人重症疟疾诊断和治疗国家指南的应用情况。我们对2008年布基纳法索东部法达恩古尔马地区医院急诊科收治的重症疟疾患者的病历进行了回顾性研究；通过简单随机抽样选取了165份病历。我们报告了疟疾的所有严重临床和生物学体征及其治疗情况。我们将其与国家指南中重症疟疾的诊断和治疗标准进行了比较。患者的平均年龄为38±16.2岁，男女比例为0.96。最常见的入院时间为7月至10月。142例（86.1%）报告有发热或近期有发热史。根据重症疟疾的两个标准（即至少存在一种相关严重体征且恶性疟原虫血症阳性），我们注意到只有74例（44.8%）有至少一种严重体征，这些体征包括：贫血（51.3%）、心血管衰竭（7.9%）、黄疸（7.3%）、呼吸困难（6.7%）、意识障碍（5.5%）、虚脱（5.5%）、肾衰竭（4.8%）、低血糖（2.4%）、出血（1.8%）和惊厥（1.2%）。生物学体征未进行系统检查。91例（55.1%）进行了寄生虫学检查。仅18例阳性（19.8%）。总共只有18例（10.9%）符合指南中重症疟疾的标准。其他病例被过度诊断；注意其中74例（50.3%）的调查不完整。在165例病例中，146例（88.5%）治疗得当，19例（11.5%）未接受疟疾治疗。
我们观察到成人重症疟疾存在过度诊断的情况，以至于我们可以认为由于缺乏生物学检查，该疾病存在诊断不足的问题。
