Brasseur P, Raccurt C, Badiane M, Cisse M, Trape J-F, Sokhna C
IRD, URMITE-IRD 198-UM 63-CNRS 7278-INSERM U, 1095-Université Aix-Marselle, Dakar, Sénégal.
Laboratoire National de Santé Publique, Port-au-Prince, Haïti.
Bull Soc Pathol Exot. 2015 Feb;108(1):10-3. doi: 10.1007/s13149-014-0404-3. Epub 2014 Nov 18.
Before 2006 in Senegal, in the absence of clinical diagnosis, all fever cases were considered as malaria and treated with chloroquine. Between 2004-2006, to face the dramatic increase of Plasmodium falciparum resistance to chloroquine, the combination of amodiaquine plus sulfadoxine-pyriméthamine was recommended for treatment. In 2006, rapid diagnostic tests were introduced and the treatment with a combination of artesunate plus amodiaquine (ASAQ) became the national recommendation for malaria treatment in 2007. This coincided with a decrease of the prevalence of malaria cases and change in fever management. Since 1995 in Mlomp in Casamance, thin and thick blood smear examination has systematically been done in patients with fever and clinical signs of malaria, and treatment with ASAQ given as experimental procedure. Between 2000 and 2012, 70,892 outpatients were attending the health center, and 51.2% of them for fever. Among these fever cases, 72.4% were suspected of malaria and 27.6% were identified as bacterial and viral infections. Confirmed malaria cases decreased dramatically from 1365 in 2000 to 53 in 2012. While comparing the 2 periods 2000-2006 and 2007-2012, the number of fever cases decreased by half, the number of fever identified as non malaria doubled and malaria treatment given decreased by 86%. Improvement of fever management in Mlomp has contributed to a better identification of their cause and to a decrease of inappropriate malaria treatments.
2006年以前在塞内加尔，由于缺乏临床诊断，所有发热病例都被视为疟疾并用氯喹治疗。在2004年至2006年期间，为应对恶性疟原虫对氯喹耐药性的急剧增加，推荐使用阿莫地喹联合磺胺多辛-乙胺嘧啶进行治疗。2006年引入了快速诊断检测，青蒿琥酯联合阿莫地喹（ASAQ）治疗在2007年成为该国疟疾治疗的推荐方法。这与疟疾病例流行率的下降以及发热管理的变化相吻合。自1995年以来，在卡萨芒斯的姆隆普，对有发热和疟疾临床症状的患者系统地进行了厚薄血涂片检查，并将ASAQ治疗作为实验性程序。在2000年至2012年期间，70892名门诊患者前往该健康中心就诊，其中51.2%是因发热就诊。在这些发热病例中，72.4%被怀疑患有疟疾，27.6%被确定为细菌和病毒感染。确诊的疟疾病例从2000年的1365例急剧下降到2012年的53例。在比较2000年至2006年和2007年至2012年这两个时期时，发热病例数量减少了一半，被确定为非疟疾的发热病例数量增加了一倍，疟疾治疗的病例减少了86%。姆隆普发热管理的改善有助于更好地查明病因并减少不适当的疟疾治疗。
