Pielok Łukasz, Kłudkowska Matylda, Rzymski Stanisław, Stefaniak Jerzy
Department of Tropical and Parasitic Diseases, Poznan University of Medical Sciences, Poznań, Poland
Central Laboratory of Microbiology, H. Święcicki University Hospital, Poznań, Poland
Ann Parasitol. 2019;65(4):427–431. doi: 10.17420/ap6504.231.
Malaria is one of the most life-threatening parasitic diseases caused by the protozoa of the genus Plasmodium, occurring in the tropical and subtropical regions. Misdiagnosed infection can progress to a wide range of life-threatening pathologies, including severe anemia and cerebral malaria which can lead to death even few days after first symptoms appearance. Cerebral malaria is rare in adults and most cases are connected to children under 5 years old living in malaria endemic areas. In this article we describe cerebral malaria caused by the Plasmodium falciparum in a 45-year-old Polish patient, who traveled to Cameroon without any malaria prophylaxis. The patient had been treated in an intensive care unit because of multi-organ dysfunction as a result of the delayed malaria diagnosis. The presence of thrombocytopenia, anemia, metabolic acidosis, acute respiratory distress syndrome and multi-organ dysfunction involving liver, kidneys, and brain created an image of advanced severe malaria. Loss of consciousness, GCS 6, and the presence of asexual Plasmodium falciparum forms in blood films are the evidence of cerebral malaria. To avoid development of cerebral malaria, the illness should be diagnosed immediately. The cerebral malaria can occur also in adult healthy individuals. Appropriate treatment with intravenous artemisine can protect the patient from lifethreatening complications. Prolonged anemia after treatment can be a consequence of artemisine usage as well as a severe malaria sequel.
疟疾是由疟原虫属原生动物引起的最具生命威胁的寄生虫病之一，发生在热带和亚热带地区。误诊的感染可能发展为多种危及生命的病症，包括严重贫血和脑型疟疾，甚至在首次出现症状后几天就可能导致死亡。脑型疟疾在成年人中很少见，大多数病例与生活在疟疾流行地区的5岁以下儿童有关。在本文中，我们描述了一名45岁的波兰患者因恶性疟原虫引起的脑型疟疾，该患者前往喀麦隆时未采取任何疟疾预防措施。由于疟疾诊断延迟导致多器官功能障碍，患者在重症监护病房接受治疗。血小板减少、贫血、代谢性酸中毒、急性呼吸窘迫综合征以及涉及肝脏、肾脏和大脑的多器官功能障碍呈现出晚期严重疟疾的症状。意识丧失、格拉斯哥昏迷评分6分以及血片中出现恶性疟原虫无性体是脑型疟疾的证据。为避免脑型疟疾的发展，应立即诊断病情。脑型疟疾也可能发生在健康的成年人身上。静脉注射青蒿素进行适当治疗可保护患者免受危及生命的并发症。治疗后长期贫血可能是使用青蒿素的结果，也是严重疟疾的后遗症。
