Che Rahim Mohd Jazman, Mohammad Nurashikin, Besari Alwi Muhd, Wan Ghazali Wan Syamimee
Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
BMJ Case Rep. 2017 Feb 20;2017:bcr2016218480. doi: 10.1136/bcr-2016-218480.
We report a case of severe and dengue coinfection in a previously healthy 59-year-old Malay man who presented with worsening shortness of breath, high-grade fever with chills and rigors, dry cough, myalgia, arthralgia, chest discomfort and poor appetite of 1 week duration. There was a history mosquito fogging around his neighbourhood in his hometown. Further history revealed that he went to a forest in Jeli (northern part of Kelantan) 3 weeks prior to the event. Initially he was treated as severe dengue with plasma leakage complicated with type 1 respiratory failure as evidenced by positive serum NS1-antigen and thrombocytopenia. Blood for malarial parasite (BFMP) was sent for test as there was suspicion of malaria due to persistent thrombocytopenia despite recovering from dengue infection and the presence of a risk factor. The test revealed high count of malaria parasite. Confirmatory PCR identified the parasite to be Intravenous artesunate was administered to the patient immediately after acquiring the BFMP result. Severe malaria was complicated with acute kidney injury and septicaemic shock. Fortunately the patient made full recovery and was discharged from the ward after 2 weeks of hospitalisation.
我们报告了一例严重登革热合并疟疾感染的病例，患者为一名59岁既往健康的马来男性，出现进行性加重的气短、高热伴寒战及畏寒、干咳、肌痛、关节痛、胸部不适和食欲减退，病程1周。其家乡社区有过蚊虫喷洒药物史。进一步询问病史发现，发病前3周他去过吉打（吉兰丹州北部）的一片森林。最初，鉴于血清NS1抗原阳性和血小板减少，他被诊断为严重登革热伴血浆渗漏并合并1型呼吸衰竭。由于尽管登革热感染已康复但血小板持续减少且存在危险因素，怀疑有疟疾，于是送检了疟原虫血样（BFMP）检测。检测结果显示疟原虫计数很高。确诊性PCR鉴定该寄生虫为 获得BFMP结果后，立即给患者静脉注射青蒿琥酯。严重疟疾并发急性肾损伤和感染性休克。幸运的是，患者完全康复，住院2周后出院。
