Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Milano, Italy.
J Travel Med. 2011 Nov-Dec;18(6):379-85. doi: 10.1111/j.1708-8305.2011.00554.x. Epub 2011 Oct 17.
The diagnosis and treatment of malaria in non-endemic countries presents a continuing challenge.
Medical records were reviewed for 291 patients hospitalized with microscopically confirmed malaria diagnosed consecutively in two infectious diseases wards in Milano, Italy, between 1998 and 2007.
One hundred eighty-six (64%) were male; median age was 35 y (range 16-72 y). Of the 291 patients, 204 (70.1%) were non-immune travelers and 87 (29.9%) were considered semi-immune. In 228 patients (78.3%), Plasmodium falciparum was identified as the only causative malarial parasite. In 48 (16.5%), 9 (3.1%), and 1 (0.3%) cases, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae were diagnosed, respectively. Five mixed infections were observed (1.7%). Of the 233 falciparum cases (including mixed infections), 222 (95.3%) were acquired in sub-Saharan Africa. Fifty-four percent of P vivax infection were acquired in the Indian subcontinent and Southeast Asia. Chemoprophylaxis was used by 23.6% (61/258) subjects with only 32 fully compliant with the recommended regimen. At admission, fever, chills, and headache were present in 95.5, 59.5, and 55.3% of cases, respectively. Elevated serum lactate dehydrogenase levels (95%) and thrombocytopenia (82%) were the most frequently detected laboratory abnormalities. Thirty-five patients (15%) with P falciparum malaria presented with severe malaria according to the WHO criteria; in 19 patients (54.3%) more than one criteria was present. All patients recovered uneventfully. Inappropriate anti-malarial treatment occurred in 25 patients (8.6%) and were recorded more frequently among patients with a diagnosis of P vivax malaria (29.1%) as opposed to those affected by P falciparum (3.9%).
In our study more than two thirds of imported malaria cases were due to P falciparum with an excess of cases diagnosed in immigrants starting from the year 2000. Despite many available guidelines inappropriate initial malaria treatment is relatively frequent even when patients are managed in an infectious diseases ward.
在非疟疾流行国家，疟疾的诊断和治疗仍然是一个挑战。
对 1998 年至 2007 年间意大利米兰两家传染病病房连续收治的 291 例经显微镜确诊的疟疾住院患者的病历进行了回顾性分析。
186 例（64%）为男性；中位年龄为 35 岁（范围 16-72 岁）。291 例患者中，204 例（70.1%）为非免疫旅行者，87 例（29.9%）为半免疫旅行者。228 例（78.3%）患者仅感染了恶性疟原虫。48 例（16.5%）、9 例（3.1%）和 1 例（0.3%）患者分别诊断为间日疟原虫、卵形疟原虫和三日疟原虫感染。5 例为混合感染（1.7%）。233 例恶性疟原虫感染（包括混合感染）中，222 例（95.3%）为撒哈拉以南非洲感染。54%的卵形疟原虫感染发生在南亚和东南亚。258 例患者中有 23.6%（61 例）使用了化学预防药物，但只有 32 例完全遵循了推荐的方案。入院时，95.5%、59.5%和 55.3%的患者分别出现发热、寒战和头痛。最常见的实验室异常是血清乳酸脱氢酶水平升高（95%）和血小板减少症（82%）。根据世界卫生组织标准，35 例（15%）恶性疟原虫感染患者为重症疟疾，19 例（54.3%）患者有 1 项以上标准。所有患者均痊愈。25 例（8.6%）患者接受了不适当的抗疟治疗，其中诊断为卵形疟原虫感染的患者（29.1%）比诊断为恶性疟原虫感染的患者（3.9%）更常发生这种情况。
在我们的研究中，超过三分之二的输入性疟疾病例是由恶性疟原虫引起的，自 2000 年以来，移民中诊断出的病例数量有所增加。尽管有许多可用的指南，但即使在传染病病房接受治疗，初始抗疟治疗不当的情况也相对频繁。
