严重输入性恶性疟：儿童疟疾的特征及危险分层的有用因素。

Severe imported Plasmodium falciparum malaria in children: characteristics and useful factors in the risk stratification.

机构信息

University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy.

Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall D'Hebron. PROSICS Barcelona. Universitat Autònoma de Barcelona. Barcelona, Spain.

出版信息

Travel Med Infect Dis. 2021 Nov-Dec;44:102196. doi: 10.1016/j.tmaid.2021.102196. Epub 2021 Nov 5.

DOI:10.1016/j.tmaid.2021.102196

PMID:34748988

Abstract

BACKGROUND

Severe imported pediatric malaria is of concern in non-endemic settings. We aimed to determine the features of pediatric severe cases in order to design a model able to stratify patients at presentation.

METHODS

We conducted a retrospective cross-sectional study including all imported P. falciparum malaria infection in patients ≤14 years of age, treated from January 2008 to February 2019 in two tertiary hospitals: Brescia, Italy and Barcelona, Spain. Severe malaria was defined according to World Health Organization criteria. Mortality rate, pediatric intensive care unit (PICU) stay and blood transfusion were analysed as adverse outcomes.

RESULTS

Out of 139 children included, 30.9% were severe malaria. Twenty-seven (19.4%) were admitted to PICU, and transfusion was required in 14 cases (10.1%). Predictors for severe malaria were: young age, low hemoglobin, high white blood cells (WBC) and high C-reactive protein. Platelet <130,000/μl correlated with severe malaria (without statistical significance). A model that includes age, WBC and C-reactive protein shows a high specificity to classify patients without severe malaria (92.3%) with 70% PPV and 75% NPV.

CONCLUSIONS

A score based on patient's age, WBC and C-reactive protein easily available at emergency room can help to identify children with higher risk of adverse outcomes.

摘要

背景

在非流行地区，严重的输入性儿童疟疾令人担忧。我们旨在确定儿科重症病例的特征，以便设计一种能够在就诊时对患者进行分层的模型。

方法

我们进行了一项回顾性横断面研究，纳入了 2008 年 1 月至 2019 年 2 月在意大利布雷西亚和西班牙巴塞罗那的两家三级医院治疗的所有年龄≤14 岁的输入性恶性疟原虫感染患者。严重疟疾的定义根据世界卫生组织的标准。分析死亡率、儿科重症监护病房（PICU）入住率和输血作为不良结局。

结果

共纳入 139 例儿童，30.9%为严重疟疾。27 例（19.4%）患儿入住 PICU，14 例（10.1%）需要输血。严重疟疾的预测因素为：年龄较小、血红蛋白低、白细胞（WBC）高和 C 反应蛋白高。血小板<130,000/μl 与严重疟疾相关（无统计学意义）。包括年龄、WBC 和 C 反应蛋白的模型显示出较高的特异性，可以分类没有严重疟疾的患者（92.3%），其阳性预测值为 70%，阴性预测值为 75%。