马德里妊娠合并输入性疟疾。

Imported malaria in pregnancy in Madrid.

机构信息

Internal Medicine Department, University Hospital Fuenlabrada, Madrid, Spain.

出版信息

Malar J. 2012 Apr 11;11:112. doi: 10.1186/1475-2875-11-112.

DOI:10.1186/1475-2875-11-112

PMID:22494463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3350381/

Abstract

BACKGROUND

Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce.The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain.

METHODS

Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records.

RESULTS

There were 19 pregnant women among 346 malaria cases (5.4%). The average age was 27 years. The gestational age (trimester) was: 53% 3rd, 31% 1st, 16% 2nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89%) had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice.

PRESENTATION

16 symptomatic patients (fever in fourteen, asthenia in two), three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl) 78.9% (mild 31.6%, moderate 31.6%, severe 15.8%) thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to Plasmodium falciparum, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%.

OUTCOMES

no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up.

CONCLUSIONS

Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic, malaria should always be considered in patients with unexplained anaemia arriving from endemic areas. These findings could help Maternal Health programme planners and implementers to target preventive interventions in the immigrant population and should create awareness among clinicians.

摘要

背景

疟疾在妊娠期间与流行地区的母婴发病率和死亡率有关，但有关输入性病例的信息在非流行地区却很少。本研究的目的是描述西班牙马德里两家综合医院妊娠疟疾的临床和流行病学特征。

方法

对费恩拉布拉达大学医院和阿斯特雷斯王子大学医院在六年和十一年期间确诊的妊娠疟疾妇女进行回顾性描述性研究。从病历中获取相关的流行病学、临床和实验室数据。

结果

在 346 例疟疾病例中，有 19 例是孕妇（5.4%）。平均年龄为 27 岁。妊娠（妊娠）期为：3 期 53%，1 期 31%，2 期 16%。除 1 例外，其余均为多产妇。3 例 HIV 阳性。均为撒哈拉以南移民：2 例为新移民，17 例（89%）为探亲访友。无人服用预防药物，也无人寻求旅行前咨询。

表现

16 例有症状患者（发热 14 例，乏力 2 例），3 例无症状。中位诊断延迟时间：7.5 天。实验室检查：贫血（Hb 水平 11 g/dl 为截断值）78.9%（轻度 31.6%，中度 31.6%，重度 15.8%）血小板减少 73.7%，低血糖 10.5%。所有病例均为恶性疟原虫所致，1 例为超寄生。84%开了奎宁+克林霉素。

结果

无严重母婴并发症或死亡，2 例流产，15 例足月妊娠，无低出生体重儿，2 例患者失访。

结论

尽管妊娠疟疾病例并不常见，但显然有一个高危人群：年轻的撒哈拉以南母亲探亲访友，没有旅行前咨询，还有新移民。最常见的母婴和胎儿不良影响是贫血和死产。鉴于无症状的表现，对于来自流行地区且原因不明的贫血患者，应始终考虑疟疾。这些发现可以帮助妇幼保健规划者和实施者针对移民人口实施预防干预措施，并应提高临床医生的认识。