Infectious Diseases Unit. Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy.
Mediterr J Hematol Infect Dis. 2012;4(1):e2012026. doi: 10.4084/MJHID.2012.026. Epub 2012 May 4.
The first symptoms of malaria, common to all the different malaria species, are nonspecific and mimic a flu-like syndrome. Although fever represents the cardinal feature, clinical findings in malaria are extremely diverse and may range in severity from mild headache to serious complications leading to death, particularly in falciparum malaria. As the progression to these complications can be rapid, any malaria patient must be assessed and treated rapidly, and frequent observations are needed to look for early signs of systemic complications.In fact, severe malaria is a life threatening but treatable disease. The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea) may lead physicians who see malaria infrequently to a wrong diagnosis, such as influenza (particularly during the seasonal epidemic flu), dengue, gastroenteritis, typhoid fever, viral hepatitis, encephalitis. Physicians should be aware that malaria is not a clinical diagnosis but must be diagnosed, or excluded, by performing microscopic examination of blood films. Prompt diagnosis and appropriate treatment are then crucial to prevent morbidity and fatal outcomes. Although Plasmodium falciparum malaria is the major cause of severe malaria and death, increasing evidence has recently emerged that Plasmodium vivax and Plasmodium knowlesi can also be severe and even fatal.
疟疾的最初症状是所有不同疟原虫都具有的非特异性症状，类似于流感样综合征。虽然发热是主要特征，但疟疾的临床症状极其多样，严重程度从轻度头痛到严重并发症导致死亡不等，尤其是在恶性疟原虫感染中。由于这些并发症的进展可能很快，任何疟疾患者都必须迅速进行评估和治疗，需要密切观察以寻找全身并发症的早期迹象。事实上，严重疟疾是一种危及生命但可治疗的疾病。疟疾中出现的多样且非特异性的临床症状（发热、不适、头痛、肌痛、黄疸，有时还伴有恶心、呕吐和腹泻等胃肠道症状）可能导致不常诊治疟疾的医生误诊，如流感（特别是季节性流感流行期间）、登革热、肠胃炎、伤寒、病毒性肝炎、脑炎。医生应该认识到疟疾不是一种临床诊断，必须通过镜检血片来诊断或排除疟疾。及时诊断和适当治疗对于预防发病率和致死结局至关重要。尽管恶性疟原虫疟疾是严重疟疾和死亡的主要原因，但最近有越来越多的证据表明，间日疟原虫和诺氏疟原虫也可能导致严重疟疾，甚至导致死亡。
