Fundação de Medicina Tropical Dr, Heitor Vieira Dourado, Av, Pedro Teixeira, 25, 69040-000, Manaus Amazonas, Brazil.
Malar J. 2012 Jan 9;11:12. doi: 10.1186/1475-2875-11-12.
The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out.
消除疟疾议程的复兴和严重表现报告数量的增加促使人们重新关注间日疟原虫感染。它是导致人类疟疾的地理分布最广的寄生虫，约有 28.5 亿人生活在感染风险之中。巴西亚马逊地区报告的疟疾病例占拉丁美洲的 50%以上，自 1990 年以来，该地区间日疟原虫的发病率明显上升，2009 年占病例的 85%。然而，该地区仅报告了少数几例复杂的间日疟病例。对巴西索引文献和非索引文献中关于复杂间日疟病例的系统综述包括已发表的文章、硕士论文、博士论文和全国大会摘要。检索到以下信息：患者特征（人口统计学、合并症存在情况，如有可能，还有相关的遗传疾病）；每一种主要临床表现的描述。结果发现，1987 年以后仅发现了 27 篇文章、28 篇科学活动纪事摘要和 13 篇论文/论文。报告的信息大部分是关于来自亚马逊所有州的小病例系列和患者病例报告，以及来自巴西非流行地区的旅行者的信息。更相关的临床并发症包括贫血、血小板减少、黄疸和急性呼吸窘迫综合征，所有年龄段均有发生，此外还有其他更罕见的临床表现。也有孕妇并发症的报告。急性和慢性合并症很常见，但偶尔会死亡。疟疾的非典型临床病例比索引文献中发表的要多，这可能是由于发表偏倚。在巴西亚马逊地区（被认为是传播强度低到中度的地区），临床数据与在不同间日疟流行地区描述的严重程度的最新发现一致（尤其是东南亚的贫血），但该地区儿童和成人都受到影响。最后，适当地指出了知识空白和未来研究领域。
