Mehta S R, Naidu G, Chandar V, Singh I P, Johri S, Ahuja R C
J Assoc Physicians India. 1989 Apr;37(4):264-7.
Clinical details and present day problems encountered in 425 cases of falciparum malaria (PF) are reported. 10.11% had taken chloroquine prior to reporting to us. Parasitic count done in 23.05% cases lacked correlation with severity of disease. Pattern of fever varied markedly but 5.4% were afebrile throughout and presented only with bodyache and malaise. Apyrexial spell was noted in 5.64%. 28.70% had typical facial looks of anaemia and sallow complexion. Cerebral symptoms were noted in 3.05%. Other symptoms were severe headache 33.4%, pain abdomen 3.29%, gastroenteritis 5.64%, jaundice 2.58% and bronchitis in 7.50%. We encountered subconjunctival haemorrhages with purpura and/or urticaria in four cases, symptoms suggestive of shock lung in 3, pulmonary oedema in 2, severe anaemia (HB less than 4 g%) in seven pregnant ladies, extrapyramidal symptoms in follow up period in 5 and congenital malaria in 2 cases. 83.25% were cured with chloroquine and oxytetracycline. 8.47% (who deteriorated despite the above treatment) were treated with quinine for 6 days. 5.17% (with severe disease) were also given quinine as first line drug. 2.82% (unresponsive to chloroquine and oxytetracycline but with mild disease) were treated with pyrimethamine-sulphamezathine combination for 5 days. One case who did not respond to quinine was treated with quinidine. Recrudescence was seen in 3.67% of patients treated with chloroquine and oxytetracycline. There was no case with renal failure, haemolysis due to G6PD deficiency and black water fever. There was only one death (0.23%) in our series. Self-medication, haphazard therapy and the slogan "Fever may be malaria-take chloroquine" can lead to problems in falciparum malaria.
报告了425例恶性疟（PF）患者的临床细节及当前遇到的问题。10.11%的患者在前来就诊前服用过氯喹。23.05%的病例进行了寄生虫计数，但与疾病严重程度缺乏相关性。发热模式差异显著，5.4%的患者始终无发热，仅表现为身体疼痛和不适。5.64%的患者出现无热期。28.70%的患者有典型的贫血面容和面色蜡黄。3.05%的患者出现脑部症状。其他症状包括严重头痛33.4%、腹痛3.29%、肠胃炎5.64%、黄疸2.58%以及支气管炎7.50%。我们遇到4例伴有紫癜和/或荨麻疹的结膜下出血，3例有提示休克肺的症状，2例有肺水肿，7例孕妇有严重贫血（血红蛋白低于4g%），5例在随访期出现锥体外系症状，2例有先天性疟疾。83.25%的患者用氯喹和土霉素治愈。8.47%（尽管上述治疗病情仍恶化）的患者用奎宁治疗6天。5.17%（患有严重疾病）的患者也将奎宁作为一线药物使用。2.82%（对氯喹和土霉素无反应但病情较轻）的患者用乙胺嘧啶 - 磺胺甲嘧啶联合治疗5天。1例对奎宁无反应的患者用奎尼丁治疗。在接受氯喹和土霉素治疗的患者中，3.67%出现复发。没有出现肾衰竭、葡萄糖 - 6 - 磷酸脱氢酶（G6PD）缺乏导致的溶血和黑水热病例。我们的系列病例中仅有1例死亡（0.23%）。自我用药、随意治疗以及“发热可能是疟疾，服用氯喹”的口号可能会给恶性疟带来问题。
