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最致命的人类原生动物寄生虫是恶性疟原虫:严重疟疾相关的急性肾衰竭——一例报告。

The most lethal human protozoan parasite is plasmodium falciparum: severe malaria-associated acute renal failure - a case report.

作者信息

Bereda Gudisa

机构信息

Pharmacy Department, All Africa Leprosy, Tuberculosis and Rehabilitation Training Centre, Zenebework, Kolfe Keranio, Addis Ababa, Ethiopia.

出版信息

Ann Med Surg (Lond). 2024 Oct 28;86(12):7314-7317. doi: 10.1097/MS9.0000000000000988. eCollection 2024 Dec.

Abstract

INTRODUCTION AND IMPORTANCE

Malaria continues to be a significant global public health problem, particularly in endemic nations. The most common cause of acute renal failure is a infection.

CASE PRESENTATION

A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and a lack of appetite. The patient had no prior history of malaria. He was not given any antimalarial medication as prophylaxis while traveling to his workplace. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient's blood. At the border of the colitis, the liver was palpable. Both the chest radiograph and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. He received 1000 ml of normal saline solution with 40% glucose solution as part of his supportive care. He received intravenous artesunate 60 mg (2.4 mg/kg) when he was admitted to an ICU, and then every 12 and 24 h for the next 3 days (a total of three doses, 540 mg).

CLINICAL DISCUSSION

A typical symptom of severe malaria is acute kidney injury, which also carries its own risk of death. In regions with active transmission, is recognized as a significant contributor to acute renal damage.

CONCLUSION

The mechanism proposed for kidney injury by severe malaria is hemodynamic dysfunction, followed by inflammation and immunological dysregulation in the patient in this study. He had reduced serum sodium levels within the red blood cells, which led to calcium influx into the cell, altering the red blood cell's deformability.

摘要

引言与重要性

疟疾仍然是一个重大的全球公共卫生问题,尤其是在疟疾流行国家。急性肾衰竭最常见的病因是感染。

病例介绍

一名28岁男性因严重疲劳、寒战、发热和食欲不振被送入急诊室。该患者既往无疟疾病史。他在前往工作场所途中未接受任何抗疟药物预防。通过使用薄血涂片和厚血涂片对外周血中的疟原虫进行实验室检查,在患者血液中发现了疟原虫。在结肠炎边界处可触及肝脏。胸部X光片和腹部超声检查均正常。他的意识水平评估显示格拉斯哥昏迷评分为15分中的10分。作为支持治疗的一部分,他接受了1000毫升含40%葡萄糖溶液的生理盐水。他入住重症监护病房时接受了60毫克(2.4毫克/千克)静脉注射青蒿琥酯,随后在接下来的3天里每12小时和24小时各注射一次(共三剂,540毫克)。

临床讨论

严重疟疾的典型症状是急性肾损伤,这本身也有死亡风险。在疟疾传播活跃的地区,被认为是急性肾损伤的重要原因。

结论

本研究中,严重疟疾导致肾损伤的机制是血流动力学功能障碍,随后是炎症和免疫调节异常。患者红细胞内血清钠水平降低,导致钙流入细胞,改变了红细胞的变形能力。

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本文引用的文献

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Malaria and acute kidney injury.疟疾与急性肾损伤。
Pediatr Nephrol. 2020 Apr;35(4):603-608. doi: 10.1007/s00467-018-4191-0. Epub 2019 Jan 31.
7
Kidney involvement in malaria: an update.疟疾中的肾脏受累:最新进展。
Rev Inst Med Trop Sao Paulo. 2017;59:e53. doi: 10.1590/S1678-9946201759053. Epub 2017 Aug 3.
8
Acute kidney injury in a shepherd with severe malaria: a case report.一名患有严重疟疾的牧羊人发生急性肾损伤:病例报告
Int J Nephrol Renovasc Dis. 2016 Oct 11;9:249-251. doi: 10.2147/IJNRD.S116377. eCollection 2016.

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