Assistance Publique - Hôpitaux de Paris, Robert Debré Mother - Child University Hospital, Pediatric Emergency Department, 48 boulevard Sérurier 75019 Paris, France.
Assistance Publique - Hôpitaux de Paris, Robert Debré Mother - Child University Hospital, General Pediatrics Department, 48 boulevard Sérurier 75019 Paris, France.
Arch Pediatr. 2022 May;29(4):300-306. doi: 10.1016/j.arcped.2022.01.014. Epub 2022 Mar 11.
Plasmodium falciparum hyperparasitemia (over or equal to 10%), isolated or associated with other severity criteria, should be managed in a pediatric intensive care unit according to the French pediatric guidelines. The main objective of our study was to describe the management and course of these special cases.
We conducted a retrospective study in eight French hospital facilities from January 2007 to December 2014. We reviewed the management of non-immune children aged 0-15 years, assessing the following: clinical and paraclinical data, type of care unit, treatment initiated, initial and long-term course. Data were analyzed for the whole population and for two groups according to the place of first-line management: group A (in pediatric intensive care unit), and group B (other places).
A total of 61 children were included, 14 (23%) of whom were initially admitted to the intensive care unit (group A), all with neurological or hemodynamic disorders. Only 23 children (38%) overall received intravenous antimalarial treatment and the other patients received exclusively oral treatment. No deaths were reported. Median parasitemia was comparable in the two groups. In group B (n = 47/61, 77%), isolated hyperparasitemia, jaundice, and renal failure were predominant. The children who underwent initial intravenous treatment (n = 5/47, 11%) all progressed favorably, as did 92% of the children who received oral treatment (n = 42/47, 89%).
A majority of children with Plasmodium falciparum hyperparasitemia were managed outside the pediatric intensive care unit via the oral route, against the French pediatric guidelines except when neurologic or hemodynamic disorders were present. Initial clinical evaluation and hospital supervision are essential for the best management of these patients.
根据法国儿科指南，恶性疟原虫高寄生血症（超过或等于 10%），无论是否伴有其他严重程度标准，均应在儿科重症监护病房进行治疗。本研究的主要目的是描述这些特殊病例的治疗方法和过程。
我们对 2007 年 1 月至 2014 年 12 月期间法国 8 家医院的患者进行了回顾性研究。我们评估了年龄为 0-15 岁的非免疫儿童的临床和实验室数据、护理单元类型、治疗开始、初始和长期过程。我们对所有人群以及根据一线治疗地点分为两组进行了数据分析：A 组（在儿科重症监护病房）和 B 组（其他地方）。
共纳入 61 例患儿，其中 14 例（23%）患儿最初被收入重症监护病房（A 组），均伴有神经或血流动力学障碍。仅有 23 例（38%）患儿接受了静脉抗疟治疗，其余患儿接受了单纯的口服治疗。无死亡病例报告。两组的中位寄生虫血症水平相似。B 组（n=47/61，77%）中，孤立性高寄生血症、黄疸和肾衰竭更为常见。接受初始静脉治疗的患儿（n=5/47，11%）均病情好转，接受口服治疗的患儿（n=42/47，89%）中 92%也病情好转。
大多数恶性疟原虫高寄生血症患儿均在儿科重症监护病房之外通过口服途径进行治疗，这与法国儿科指南不符，除非存在神经或血流动力学障碍。初始临床评估和医院监护对于这些患者的最佳治疗至关重要。
