McCaslin R I, Pikis A, Rodriguez W J
Emergency Medical Trauma Center, Children's National Medical Center, Washington, DC.
Pediatr Infect Dis J. 1994 Aug;13(8):709-15.
From 1983 to 1992 a total of 64 children were admitted with a diagnosis of malaria to Children's National Medical Center in Washington, DC. Specific etiology is available in 59 of 64. Of these 59 cases 52 (88%) were caused by Plasmodium falciparum. Fifty-one of 52 infections were acquired in Africa, 35 (67%) of these in traveling United States citizens. Eleven (21%) of 52 children were initially admitted to the Intensive Care Unit for i.v. quinidine or quinine therapy. Eight (73%) of these 11 patients compared with 12 (29%) of 41 general ward admissions had been misdiagnosed within 10 days before admission (P = 0.012). Five of 11 Intensive Care Unit patients underwent exchange transfusion. One child died and one was left with severe neurologic deficit. Malaria must be considered in the differential diagnosis for any febrile child who has traveled to or from a malarious area within the previous 12 months. Delayed diagnosis of pediatric Plasmodium falciparum malaria is associated with an increased severity of illness. Because of the frequency of international travel, United States physicians will need to be familiar with the presentation and management of imported P. falciparum malaria.
1983年至1992年期间，华盛顿特区儿童国家医疗中心共收治了64例诊断为疟疾的儿童患者。64例中有59例明确了具体病因。在这59例病例中，52例（88%）由恶性疟原虫引起。52例感染中有51例是在非洲感染的，其中35例（67%）是美国旅行者感染的。52例儿童中有11例（21%）最初因静脉注射奎尼丁或奎宁治疗而入住重症监护病房。这11例患者中有8例（73%）与普通病房收治的41例患者中的12例（29%）相比，在入院前10天内被误诊（P = 0.012）。11例重症监护病房患者中有5例接受了换血治疗。1名儿童死亡，1名儿童留下严重神经功能缺损。对于任何在过去12个月内去过疟疾流行地区或来自疟疾流行地区的发热儿童，鉴别诊断时必须考虑疟疾。小儿恶性疟原虫疟疾的延迟诊断与疾病严重程度增加有关。由于国际旅行的频繁，美国医生需要熟悉输入性恶性疟原虫疟疾的表现和管理。
