Demiroğlu Yusuf Ziya, Kozanoğlu Ilknur, Turunç Tuba, Kurşun Ebru, Arslan Hande
Başkent University Adana Teaching and Research Center, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey.
Mikrobiyol Bul. 2012 Jul;46(3):493-8.
Plasmodium falciparum malaria is a type of malaria with high fatality rate despite optimal antimalarial treatment. Exchange transfusion (ET) is successfully used as a means of supportive therapy in severe P. falciparum malaria cases with hyperparasitemia. Herein, we present a case with hyperparasitemia, who received erythrocyte ET therapy due to lack of clinical response to antimalarial treatment. A 24-year-old male patient was admitted to our emergency clinic with the complaints of fever that persisted for 10 days, headache, nausea-vomiting, and impaired consciousness. Medical history revealed that he had been working in Sudan, Africa and returned back 12 days ago. On physical examination; he had fever, hypotension, tachycardia, subicterus and impaired cooperation. Laboratory examination revealed pancytopenia, elevated C-reactive protein, hyperbilirubinemia, hyponatremia, elevated creatinine level and hematuria. On thick blood smear and thin blood smear examinations, multiple (> 5%) trophozoites and gametocytes indicating P.falciparum species were observed. The case was diagnosed as P.falciparum malaria and parenteral fluid support, dopamine infusion, meropenem (IV), doxycycline (PO) and quinine sulphate (PO) were initiated in the intensive care unit. On reevaluation of the patient on the third day of hospitalization, it was observed that arterial hypotension and fever were persistent, anemia and trombocytopenia deteriorated and on thick blood smear parasitemiea was not decreased. It was decided to apply automated erythrocyte ET. After ET, patient's medical status was quickly improved and patient was discharged on the 7th day of hospitalization. In conclusion, it was noted that in addition to antimalarial treatment, erythrocyte ET may provide dramatic improvement in severe cases of P.falciparum malaria with hyperparasitemia.
恶性疟原虫疟疾是一种即便接受了最佳抗疟治疗仍具有高死亡率的疟疾类型。换血疗法（ET）已成功用作重度恶性疟原虫高疟原虫血症病例的支持性治疗手段。在此，我们报告一例高疟原虫血症病例，该患者因对抗疟治疗无临床反应而接受了红细胞换血疗法。一名24岁男性患者因持续发热10天、头痛、恶心呕吐及意识障碍被收入我院急诊科。病史显示他一直在非洲苏丹工作，12天前返回。体格检查发现他发热、低血压、心动过速、轻度黄疸且配合不佳。实验室检查显示全血细胞减少、C反应蛋白升高、高胆红素血症、低钠血症、肌酐水平升高及血尿。在厚血涂片和薄血涂片检查中，观察到多个（>5%）指示恶性疟原虫种类的滋养体和配子体。该病例被诊断为恶性疟原虫疟疾，并在重症监护病房开始给予肠外液体支持、多巴胺输注、美罗培南（静脉注射）、多西环素（口服）和硫酸奎宁（口服）。在住院第三天对患者进行重新评估时，发现动脉低血压和发热持续存在，贫血和血小板减少恶化，厚血涂片检查疟原虫血症未降低。决定实施自动红细胞换血疗法。换血疗法后，患者的病情迅速改善，并于住院第7天出院。总之，值得注意的是，除抗疟治疗外，红细胞换血疗法可能会使重度恶性疟原虫高疟原虫血症病例得到显著改善。
