Hwang Jeong-Hwan, Lee Chang-Seop
Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Republic of Korea.
Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Republic of Korea
Am J Trop Med Hyg. 2014 Dec;91(6):1094-100. doi: 10.4269/ajtmh.14-0190. Epub 2014 Oct 6.
Splenic infarction is a rare complication of malaria. We report two recent cases of splenic infarction after Plasmodium vivax infection. No systematic review of malaria-induced splenic infarction was available, therefore we conducted a systematic review of the English, French, and Spanish literature in PubMed and KoreaMed for reports of malaria-associated splenic infarction from 1960 to 2012. Of the 40 cases collected on splenic infarction by Plasmodium species, 23 involved P. vivax, 11 Plasmodium falciparum, one Plasmodium ovale, and five a mixed infection of P. vivax and P. falciparum. Of the 40 cases, 2 (5.0%) involved splenectomy and 5 (12.5%) were accompanied by splenic rupture. The median time from symptom onset to diagnosis was 8.5 days (range, 3-90 days). Improved findings after treatment were observed in 8 (88.9%) of 9 patients with splenic infarction on follow-up by computed tomography or ultrasonography. All patients survived after treatment with the exception of one patient with cerebral malaria. Clinicians should consider the possibility of splenic infarction when malaria-infected patients have left upper quadrant pain.
脾梗死是疟疾的一种罕见并发症。我们报告了两例近期间日疟原虫感染后发生脾梗死的病例。目前尚无关于疟疾所致脾梗死的系统综述，因此我们在PubMed和KoreaMed中对1960年至2012年期间英文、法文和西班牙文文献中有关疟疾相关性脾梗死的报告进行了系统综述。在按疟原虫种类收集的40例脾梗死病例中，23例由间日疟原虫引起，11例由恶性疟原虫引起，1例由卵形疟原虫引起，5例为间日疟原虫和恶性疟原虫混合感染。在这40例病例中，2例（5.0%）接受了脾切除术，5例（12.5%）伴有脾破裂。从症状出现到诊断的中位时间为8.5天（范围3 - 90天）。在9例脾梗死患者中，8例（88.9%）在随访时通过计算机断层扫描或超声检查观察到治疗后病情改善。除1例脑型疟患者外，所有患者治疗后均存活。当疟疾感染患者出现左上腹疼痛时，临床医生应考虑脾梗死的可能性。
