Department of Medicine Solna/Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
Malar J. 2012 Sep 17;11:328. doi: 10.1186/1475-2875-11-328.
In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms.Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT) may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily) until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT) or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the absorption of anti-malarials are important considerations in the choice of treatment.Complicated malaria is treated with intravenous artesunate resulting in a much more rapid decrease in parasite density compared to quinine. Patients treated with intravenous artesunate should be closely monitored for haemolysis for four weeks after treatment. There is a concern in some countries about the lack of artesunate produced according to Good Manufacturing Practice (GMP).
在这份立场文件中，欧洲临床微生物学和传染病学会临床寄生虫学研究组总结了处理输入性疟疾病例的主要问题。疟疾在欧洲是一种罕见的诊断，但它是一种医疗急救。旅行史是怀疑疟疾的关键，对于发热患者是强制性的。虽然几乎所有非免疫患者都有发热，但疟疾没有特定的临床体征或症状。来自疟疾流行地区的移民可能症状较少。应立即怀疑疟疾并进行疟疾诊断，金标准是吉姆萨染色厚、薄血涂片的显微镜检查。快速诊断检测（RDT）可用作初始筛选工具，但不能替代应并行进行的紧急显微镜检查。然而，显微镜检查的延迟不应导致适当治疗的延迟开始。通常应将诊断为疟疾的患者住院治疗。如果首选门诊管理，就像一些欧洲中心的做法一样，患者通常必须密切（至少每天）随访，直到临床和寄生虫学治愈。无并发症的恶性疟原虫疟疾的治疗方法是口服青蒿素联合疗法（ACT）或阿托伐醌/磺胺多辛。欧洲有两种形式的 ACT：青蒿琥酯/咯萘啶和双氢青蒿素/哌喹。ACT 也对间日疟原虫、卵形疟原虫、三日疟原虫和疟原虫知氏疟原虫有效，但这些物种可以用氯喹治疗。在排除葡萄糖 6 磷酸脱氢酶缺乏症后，用伯氨喹治疗间日疟原虫和卵形疟原虫的肝内持续型。对于儿童和孕妇等特殊患者群体，有修改后的治疗方案和药物选择用于治疗疟疾。药物相互作用的潜力和抗疟药物吸收中食物的作用是选择治疗方案的重要考虑因素。复杂的疟疾用静脉注射青蒿琥酯治疗，与奎宁相比，寄生虫密度的下降速度要快得多。静脉注射青蒿琥酯治疗的患者应在治疗后四周密切监测溶血情况。在一些国家，人们担心缺乏符合良好生产规范（GMP）的青蒿琥酯。
