Kroidl Inge, Seilmaier Michael, Berens-Riha Nicole, Bretzel Gisela, Wendtner Clemens, Löscher Thomas
Abteilung für Infektions- und Tropenmedizin (AITM), Klinikum der Ludwig-Maximilians-Universität (LMU) München.
Klinik für Hämatologie, Onkologie, Immunologie, Palliativmedizin, Infektiologie und Tropenmedizin, Klinikum Schwabing, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität München.
Dtsch Med Wochenschr. 2015 May;140(11):815-7. doi: 10.1055/s-0041-101378. Epub 2015 May 28.
A case of malaria caused by Plasmodium knowlesi is described in a 52-year-old female German traveler after returning from Thailand. P. knowlesi is a parasite of macaques in Southeast Asia and has been recognized in recent years as an important and probably increasing cause of human malaria in some areas. At least 16 cases in international travelers have been published so far. This includes four cases imported to Germany. All German patients visited forested areas in Southern Thailand inhabited by the natural monkey host prior to their illness. Most cases diagnosed in endemic areas present as mild disease. However in some patients P. knowlesi may take a severe and life-threatening course. Diagnosis is usually is based on microscopy whereas rapid tests are not reliable. However, microscopic differentiation of P. knowlesi from other plasmodium species (eg, P. malariae, P. falciparum) is difficult, especially when parasitemia is low. Thus PCR methods are required for definite species determination. Changing endemicity as well as changing tourism patterns such as the trend towards eco-tourism might increase the risk of infection for travelers even in areas which are considered as low endemic for malaria. Malaria has to be considered in all febrile patients returning from endemic areas. In Southeast Asia this has to include Plasmodium knowlesi infection. Especially if microscopy suggests P. falciparum/P. malariae double infection, or when results indicate P. malariae but the clinical presentation differs from that of quartan malaria (eg, daily fever), diagnostic procedures for P. knowlesi should be initiated. Currently available rapid diagnostic tests are not reliable for the detection of P. knowlesi. The definite diagnosis of P. knowlesi infection usually requires PCR techniques Changing tourism patterns such as the trend towards eco-tourism might increase the risk of infection for travelers even in low prevalence areas.
一名52岁德国女性旅行者从泰国归来后，被诊断出感染诺氏疟原虫引发的疟疾。诺氏疟原虫是东南亚猕猴的一种寄生虫，近年来在一些地区已被确认为人类疟疾的一个重要且可能呈上升趋势的病因。迄今为止，国际旅行者中至少已发表了16例相关病例，其中包括4例输入德国的病例。所有德国患者在患病前都去过泰国南部有天然猴宿主栖息的森林地区。在流行地区诊断出的大多数病例表现为轻症。然而，在一些患者中，诺氏疟原虫可能会导致严重且危及生命的病程。诊断通常基于显微镜检查，而快速检测并不可靠。然而，将诺氏疟原虫与其他疟原虫种类（如三日疟原虫、恶性疟原虫）进行显微镜鉴别很困难，尤其是当疟原虫血症水平较低时。因此，需要采用聚合酶链反应（PCR）方法来确定具体的疟原虫种类。疟疾流行情况的变化以及旅游模式的改变，如生态旅游的趋势，可能会增加旅行者的感染风险，即使在被认为疟疾低流行的地区也是如此。所有从流行地区归来的发热患者都必须考虑疟疾的可能性。在东南亚，这必须包括诺氏疟原虫感染。特别是当显微镜检查提示恶性疟原虫/三日疟原虫双重感染，或者结果显示为三日疟原虫但临床表现与三日疟（如每日发热）不同时，应启动针对诺氏疟原虫的诊断程序。目前可用的快速诊断检测对于检测诺氏疟原虫并不可靠。诺氏疟原虫感染的明确诊断通常需要PCR技术。旅游模式的改变，如生态旅游的趋势，可能会增加旅行者在低流行地区的感染风险。
