东伦敦输入性疟疾的流行病学和临床特征。

Epidemiology and clinical features of imported malaria in East London.

机构信息

Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.

Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK.

出版信息

J Travel Med. 2016 Sep 5;23(6). doi: 10.1093/jtm/taw060. Print 2016 Jun.

DOI:10.1093/jtm/taw060

PMID:27601534

Abstract

BACKGROUND

Malaria is the most common imported tropical disease in the United Kingdom (UK). The overall mortality is low but inter-regional differences have been observed.

METHODS

We conducted a 2-year retrospective review of clinical and laboratory records of patients with malaria attending three acute hospitals in East London from 1 April 2013 through 31 March 2015. Epidemiological and clinical characteristics of imported malaria were described and risk factors associated with severe falciparum malaria were explored.

RESULTS

In total, 133 patients with laboratory-confirmed malaria were identified including three requiring critical care admission but no deaths. The median age at presentation was 41 years (IQR 30-50). The majority of patients were males (64.7%, 86/133) and had Black or Black British ethnicity (67.5%, 79/117). West Africa was the most frequent region of travel (70.4%, 76/108). Chemoprophylaxis use was poor (25.3%, 20/79). The interval between arriving in the UK and presenting to hospital was short (median 10 days; IQR 5-15.5, n = 84). July-September was the peak season of presentation (34.6%, 46/133). Plasmodium falciparum was the commonest species (76.7%, 102/133) and 31.4% (32/102) of these patients had parasitaemia >2%. Severe falciparum malaria was documented in 36.3% (37/102) of patients and the October-March season presentation was associated with an increased risk of severity (OR 3.00; 95% CI 1.30-6.93). Black patients appeared to have reduced risk of severe falciparum malaria (OR 0.46; 95% CI 0.16-1.35) but this was not statistically significant. HIV sero-status was determined in only 27.1% (36/133) of cases. Only 8.5% (10/117) of all malaria patients were treated as outpatients.

CONCLUSION

Clinicians need to raise awareness on malaria prevention strategies, improve rates of HIV testing in tropical travellers, and familiarise themselves with ambulatory management of malaria. The relationship between season of presentation, ethnicity and severity of falciparum malaria should be explored further.

摘要

背景

疟疾是英国（UK）最常见的输入性热带病。整体死亡率较低，但存在区域间差异。

方法

我们对 2013 年 4 月 1 日至 2015 年 3 月 31 日期间在伦敦东部的三家急症医院就诊的疟疾患者的临床和实验室记录进行了为期 2 年的回顾性分析。描述了输入性疟疾的流行病学和临床特征，并探讨了与严重恶性疟原虫疟疾相关的危险因素。

结果

共确诊 133 例实验室确诊的疟疾患者，其中 3 例需要重症监护入院，但无死亡病例。发病时的中位年龄为 41 岁（IQR 30-50）。大多数患者为男性（64.7%，86/133），且具有黑人或黑人英国血统（67.5%，79/117）。西非是最常见的旅行地区（70.4%，76/108）。化学预防药物的使用率较低（25.3%，20/79）。从抵达英国到就诊的时间间隔较短（中位数为 10 天；IQR 5-15.5，n=84）。7-9 月是就诊的高峰期（34.6%，46/133）。恶性疟原虫是最常见的疟原虫种类（76.7%，102/133），其中 31.4%（32/102）的疟原虫载量>2%。36.3%（37/102）的患者确诊为严重恶性疟，10-3 月就诊季节与严重程度增加相关（OR 3.00；95%CI 1.30-6.93）。黑人患者似乎患严重恶性疟的风险较低（OR 0.46；95%CI 0.16-1.35），但无统计学意义。仅 27.1%（36/133）的病例确定了 HIV 血清状态。只有 8.5%（10/117）的疟疾患者接受门诊治疗。