Am J Trop Med Hyg. 2013 Apr;88(4):747-756. doi: 10.4269/ajtmh.12-0668. Epub 2013 Jan 28.
Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov).
疟疾仍然是一个具有挑战性的诊断，其临床表现多样，疾病严重程度范围广泛。我们使用结构化病例报告表，前瞻性评估了乌干达坎帕拉市穆拉戈医院的 1933 名患有急性恶性疟原虫疟疾的儿童。无并发症疟疾患儿与严重疾病患儿在 17 个特征方面存在显著差异。在 855 名患有严重疾病的儿童中，随着严重程度特征数量的增加，病死率也随之增加。逻辑回归确定了与死亡独立相关的五个因素：脑型疟疾、缺氧、严重血小板减少症、白细胞增多和酸中毒。聚类分析确定了两个组：一个组合包括贫血、脾肿大和白细胞增多；另一个组以死亡、严重血小板减少症和酸中毒为中心，其中包括脑型疟疾、缺氧、低血糖症和高寄生虫血症。我们的报告更新了以前对严重疟疾的临床描述，量化了显著的临床和实验室相互关系，并将有助于治疗疟疾的临床医生和计划或评估未来研究的人员（NCT00707200）（www.clinicaltrials.gov）。
