2012 年巴基斯坦拉合尔登革热疫情期间同时发生登革热和疟疾感染。

Concurrent dengue and malaria infection in Lahore, Pakistan during the 2012 dengue outbreak.

机构信息

Department of Medicine, Medical Unit 1, Allama Iqbal Medical College/Jinnah Hospital Lahore, Allama Shabbir Ahmed Usmani Road, Lahore 54590, Pakistan.

出版信息

Int J Infect Dis. 2014 Jan;18:41-6. doi: 10.1016/j.ijid.2013.09.007. Epub 2013 Oct 24.

DOI:10.1016/j.ijid.2013.09.007

PMID:24183717

Abstract

INTRODUCTION

We conducted this study to determine the frequency of malaria and dengue-malaria co-infection in patients admitted to our hospital as 'probable' cases of dengue fever during the 2012 outbreak of dengue, and to ascertain whether dengue-malaria co-infection was more severe than either infection alone.

METHODS

This cross-sectional observational study was conducted at Jinnah Hospital Lahore, Pakistan between August and November 2012. Patients with 2-10 days of fever and with two or more of the following: myalgia, arthralgia, retro-orbital pain, headache, skin rash, and hemorrhagic manifestations plus thrombocytopenia and leukopenia, were classified as probable cases of dengue fever and were subjected to reverse transcriptase (RT)-PCR and/or dengue-specific IgM by ELISA. The diagnosis of malaria was established on thick and thin blood film microscopy. Severe disease was defined by the presence of an altered level of consciousness, World Health Organization grade ≥2 bleeding, jaundice, circulatory shock, hemoglobin <50g/l, platelet count <50×10(9)/l, serum creatinine >265μmol/l, or death.

RESULTS

There were 85 probable cases of dengue fever. Sixty-four (75%) were male and the median age was 22 years (range 12-90 years). Of 52 patients for whom results of diagnostic tests for both dengue and malaria were available, five (10%) had isolated dengue infection, 18 (35%) isolated Plasmodium infection, and 17 (33%) dengue-malaria co-infection. Thirty-five out of 52 (67%) probable cases had malaria and 17 out of 22 (77%) dengue-specific IgM reactive patients had concurrent malaria. Patients with isolated malaria had significantly lower median hemoglobin concentrations (124.5g/l vs. 144.0 g/l, p = 0.04) and median hematocrit (36.0 vs. 41.7, p=0.02) at presentation than cases of isolated dengue. Patients with dengue-malaria co-infection had a significantly lower rate of jaundice than those with isolated dengue (0% vs. 40%, p = 0.04). The frequency of severe disease was comparable amongst the three groups; this was seen in five (100%) cases of isolated dengue, 17 (94%) cases of isolated malaria, and 16 (94%) cases of dengue-malaria co-infection.

CONCLUSIONS

The rate of isolated malaria and dengue-malaria co-infection was high in probable cases of dengue fever in our study. Except for jaundice, we could not find any significant between-group differences in the severity of the disease.

摘要

简介

本研究旨在确定在 2012 年登革热疫情期间，因疑似登革热而入院的患者中疟疾和登革热-疟疾合并感染的频率，并确定登革热-疟疾合并感染是否比单一感染更严重。

方法

本横断面观察性研究于 2012 年 8 月至 11 月在巴基斯坦拉合尔的真纳医院进行。发热 2-10 天且有以下两项或两项以上症状的患者：肌痛、关节痛、眼眶后疼痛、头痛、皮疹和出血表现，加上血小板减少和白细胞减少，被归类为疑似登革热病例，并接受逆转录酶（RT）-PCR 和/或通过酶联免疫吸附试验（ELISA）检测登革热特异性 IgM。疟疾的诊断通过厚、薄血涂片显微镜检查确定。严重疾病定义为意识改变、世界卫生组织（WHO）分级≥2 级出血、黄疸、循环休克、血红蛋白<50g/l、血小板计数<50×10(9)/l、血清肌酐>265μmol/l 或死亡。

结果

共有 85 例疑似登革热患者。64 例（75%）为男性，中位年龄为 22 岁（范围 12-90 岁）。在可获得登革热和疟疾诊断检测结果的 52 例患者中，5 例（10%）为单纯登革热感染，18 例（35%）为单纯疟原虫感染，17 例（33%）为登革热-疟疾合并感染。52 例疑似病例中有 35 例（67%）合并疟疾，22 例（77%）登革热特异性 IgM 阳性患者合并疟疾。单纯疟疾患者的中位血红蛋白浓度（124.5g/l 与 144.0g/l，p=0.04）和中位血细胞比容（36.0% 与 41.7%，p=0.02）明显低于单纯登革热患者。登革热-疟疾合并感染患者黄疸发生率明显低于单纯登革热患者（0%与 40%，p=0.04）。三组患者严重疾病的发生率相当；单纯登革热患者 5 例（100%），单纯疟疾患者 17 例（94%），登革热-疟疾合并感染患者 16 例（94%）。