Tolaj Ilir, Bunjaku Gramoz, Mehmeti Murat, Begolli Yllka
Department of Infectious Diseases, Medical Faculty, University of Pristina, 10000 Pristina, Kosovo.
Department of Infectious Diseases, University Clinical Center, 10000 Pristina, Kosovo.
Reports (MDPI). 2023 Nov 8;6(4):53. doi: 10.3390/reports6040053.
This case report presents a critical clinical scenario involving a 55-year-old patient who developed severe malaria with renal complications despite receiving doxycycline prophylaxis while traveling in a malaria-endemic region. The case emphasizes the potential failure of doxycycline prophylaxis and highlights the importance of considering malaria in patients with a history of travel to endemic areas, even if they have adhered to prophylactic treatment. The patient's clinical presentation included fever, extreme fatigue, and loss of consciousness, leading to hospitalization. Laboratory findings revealed severe anemia, elevated liver enzymes, and impaired renal function, consistent with the criteria for severe malaria. The diagnosis was confirmed by the presence of parasites on thin blood smears. Due to limited access to parenteral antimalarial medications in Kosovo, the patient received oral artemether-lumefantrine, resulting in clinical improvement. Supportive care and dialysis played a vital role in the patient's recovery. This case report underscores the need for increased awareness of prophylaxis failure, the challenges of managing severe malaria in non-endemic countries, and the importance of timely and appropriate interventions to improve outcomes in severe malaria cases, particularly those with renal involvement.
本病例报告呈现了一个危急的临床情况，涉及一名55岁的患者，该患者在疟疾流行地区旅行期间尽管接受了多西环素预防治疗，但仍患上了伴有肾脏并发症的严重疟疾。该病例强调了多西环素预防治疗可能失败，并突出了对于有前往流行地区旅行史的患者，即便他们坚持了预防性治疗，也需考虑疟疾的重要性。患者的临床表现包括发热、极度疲劳和意识丧失，最终导致住院治疗。实验室检查结果显示严重贫血、肝酶升高以及肾功能受损，符合严重疟疾的标准。通过薄血涂片发现疟原虫确诊了诊断。由于在科索沃难以获得肠胃外抗疟药物，患者接受了口服蒿甲醚-本芴醇治疗，临床症状得以改善。支持性治疗和透析在患者康复过程中发挥了至关重要的作用。本病例报告强调了提高对预防失败的认识的必要性、在非流行国家管理严重疟疾的挑战，以及及时且适当的干预措施对于改善严重疟疾病例（尤其是那些伴有肾脏受累的病例）预后的重要性。
