Smit W M, Oudemans-van Straaten H M, Zandstra D F
Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Intensive Care Med. 1990;16(8):517-9. doi: 10.1007/BF01709404.
A case of fulminant falciparum malaria with a 35% parasitaemia, shock and subcoma was treated successfully by using parenteral chemotherapy, exchange transfusion, dexamethasone, circulatory support and mechanical ventilation. Pathophysiology and complications of falciparum malaria are discussed. The treatment of severe malaria should aim for a fast reduction in parasitaemia and toxic products. An exchange transfusion can be additive to parenteral chemotherapy. Blocking the over-reacting cell-mediated immune response, aggressive shock treatment, prevention of secondary infections and maintaining normoglycaemia might reduce morbidity and mortality of fulminant falciparum malaria.
一例恶性疟原虫所致的暴发性疟疾患者，疟原虫血症达35%，出现休克和浅昏迷，通过肠外化疗、换血疗法、地塞米松、循环支持和机械通气成功治愈。文中讨论了恶性疟原虫疟疾的病理生理学及并发症。重症疟疾的治疗应以快速降低疟原虫血症及毒性产物为目标。换血疗法可辅助肠外化疗。阻断过度反应的细胞介导免疫反应、积极治疗休克、预防继发感染及维持血糖正常可能会降低暴发性恶性疟原虫疟疾的发病率和死亡率。
