Unité Ecologie Evolution et Résistances Parasitaires (UNEEREP), Centre International de Recherches Médicales de Francevillev, BP 769, Franceville, Gabon.
Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université Des Sciences Et Techniques de Masuku, BP 876, Franceville, Gabon.
Malar J. 2023 Mar 9;22(1):88. doi: 10.1186/s12936-023-04512-7.
Malaria is the most deadly parasitic disease and continues to claim more than a half million of deaths across the world each year, mainly those of under-fives children in sub-Saharan Africa. The aim of this study was to determine the epidemiological, clinical and laboratory features of patients with severe malaria at the Centre Hospitalier Régional Amissa Bongo (CHRAB), a referral hospital in Franceville.
It was an observational descriptive study conducted at CHRAB over 10 months. All admitted patients at the emergency ward of all ages presenting with positive test to falciparum malaria diagnosed by microscopy and rapid test with clinical signs of severe illness describe by World Health Organization were enrolled.
During this study, 1065 patients were tested positive for malaria, of them 220 had severe malaria. Three quarters (75.0%) were less than 5 years of age. The mean time to consultation was 3.5 ± 1 days. The most frequent signs of severity on admission were dominated by neurological disorders 92.27% (prostration 58.6% and convulsion 24.1%), followed by severe anemia 72.7%, hyperlactatemia 54.6%, jaundice 25% and respiratory distress 21.82%.The other forms such as hypoglycemia, haemoglobinuria, renal failure were found in low proportions < 10%. Twenty-one patients died, coma (aOR = 15.54, CI 5.43-44.41, p < 0.01), hypoglycemia (aOR = 15.37, CI 2.17-65.3, p < 0.01), respiratory distress (aOR = 3.85, CI 1.53-9.73, p = 0.004) and abnormal bleeding (aOR = 16.42, CI 3.57-104.73, p = 0.003) were identified as independent predictors of a fatal outcome. Anemia was associated with decreased mortality.
Severe malaria remains a public health problem affecting mostly children under 5 years. Classification of malaria helps identify the most severely ill patients and aids early and appropriate management of the severe malaria cases.
疟疾是最致命的寄生虫病，每年仍在全球夺走超过 50 万人的生命，其中主要是撒哈拉以南非洲地区 5 岁以下的儿童。本研究旨在确定法国维勒弗朗什的阿米萨邦戈地区中心医院（CHRAB）收治的重症疟疾患者的流行病学、临床和实验室特征。
这是一项在 CHRAB 进行的为期 10 个月的观察性描述性研究。所有在急诊病房就诊的年龄在 5 岁以下的所有年龄段的患者，经显微镜检查和快速检测证实为恶性疟原虫感染，且出现世界卫生组织（WHO）定义的严重疾病临床症状，均纳入本研究。
在这项研究中，有 1065 名患者的疟原虫检测呈阳性，其中 220 名患有重症疟疾。四分之三（75.0%）的患者年龄小于 5 岁。就诊的平均时间为 3.5±1 天。入院时最常见的严重症状是神经系统疾病占 92.27%（昏迷 58.6%和抽搐 24.1%），其次是严重贫血 72.7%、高乳酸血症 54.6%、黄疸 25%和呼吸窘迫 21.82%。其他形式的疾病如低血糖、血红蛋白尿、肾衰竭的比例较低，均<10%。有 21 名患者死亡，昏迷（aOR=15.54，95%CI 5.43-44.41，p<0.01）、低血糖（aOR=15.37，95%CI 2.17-65.3，p<0.01）、呼吸窘迫（aOR=3.85，95%CI 1.53-9.73，p=0.004）和异常出血（aOR=16.42，95%CI 3.57-104.73，p=0.003）被确定为死亡的独立预测因素。贫血与死亡率降低有关。
重症疟疾仍然是一个公共卫生问题，主要影响 5 岁以下儿童。疟疾分类有助于识别病情最严重的患者，并有助于对重症疟疾患者进行早期和适当的治疗。
