Özmen Çapın Büşra Betül, Sönmezer Meliha Çağla, Tortop Sema, Ünalan Tuğçe, Bölek Hatice, Altıntop Sabri Engin, İnkaya Ahmet Çağkan, Metan Gökhan, Ergüven Sibel
Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey.
Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
Mikrobiyol Bul. 2019 Oct;53(4):472-479. doi: 10.5578/mb.68419.
In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.
尽管间日疟原虫是我国疟疾的主要病原体，但最近有输入性疟疾病例的报告。在本报告中，呈现了两例源自撒哈拉以南非洲的疟疾病例及其诊断和治疗方法。首例患者为一名45岁男性，一直在加纳共和国工作，返回土耳其后因发热、出汗和寒战等症状入住哈杰泰佩大学医院急诊科。入院时，他的一般状况良好，体格检查未发现病理体征。入院后，他出现了一次发热发作，血液检查显示贫血、血小板减少和碱性磷酸酶水平升高。第二例患者为一名39岁男性，因发热、寒战和肌痛等症状入住急诊科。体格检查发现呼吸音减弱和脾肿大，实验室检查结果为全血细胞减少和肝酶升高。在患者的厚血涂片中检测到环状年轻滋养体，薄血片中一个红细胞内可见多个环状体，无成熟滋养体和裂殖体，符合恶性疟原虫疟疾。第二例患者的快速抗原检测（比利时Digamed）发现恶性疟原虫和间日疟原虫均呈阳性，由于其一般状况恶化、呼吸窘迫、血尿和意识改变，该患者在重症监护病房接受治疗。两例患者均未进行疟疾预防。两名患者所在国家普遍存在氯喹耐药情况，按照世界卫生组织目前的建议，他们接受了蒿甲醚/本芴醇治疗。针对间日疟原虫的休眠子，在第二例患者的治疗中加用了伯氨喹。两名患者均治愈。总之，前往疟疾流行国家时，应告知人们疟疾预防的重要性，应立即开始并适当持续进行预防。此外，对于有前往这些国家旅行史且因高热入院的患者，鉴别诊断时应始终考虑疟疾。
