Moore T A, Tomayko J F, Wierman A M, Rensimer E R, White A C
Department of Medicine, Baylor College of Medicine, Houston.
Arch Fam Med. 1994 Feb;3(2):130-6. doi: 10.1001/archfami.3.2.130.
To determine the frequency, the clinical features, and the response to therapy of imported malaria that was diagnosed in the 1990s in a major North American city.
A retrospective case series from Houston, Tex, of 59 cases of imported malaria presenting between January 1990 and April 1993.
Malaria was diagnosed in 59 patients, consisting of 12 cases among patients who had acquired the infection while they were living in endemic areas prior to immigration to the United States, 32 cases among US residents who were originally from endemic areas, and 15 cases among patients originally from North America or Europe. Only 12 patients had received malarial prophylaxis: eight with chloroquine, one with chloroquine and chloroguanide (proguanil), two with chloroquine and primaquine, and one with mefloquine taken intermittently. Eight presented with Plasmodium falciparum infection after receiving chloroquine, and one, after receiving chloroquine and chloroguanide. Two presented with malaria caused by Plasmodium vivax despite receiving chloroquine and primaquine as prophylaxis. In 25 cases, malaria was not considered as an initial diagnosis. Five patients presented with severe disease (three with severe hemolysis, two each with cerebral malaria and renal failure, and one with adult respiratory distress syndrome). Four of the five had initially received a misdiagnosis. Two patients died despite treatment with intravenous quinidine and exchange transfusions. Two patients with P vivax infection had multiple relapses despite courses of chloroquine and primaquine. Six patients were pregnant (including one with a fatal case), one congenital infection was identified. Six patients had not traveled outside of the United States in over 1 year.
Imported malaria occurs frequently and usually results from the failure to use appropriate prophylaxis. Delayed diagnosis and misdiagnosis are common. Severe disease and fatal cases continue to be seen despite aggressive treatment. Drug resistance has continued to spread and now occurs with P vivax as well as P falciparum.
确定20世纪90年代在北美一个主要城市诊断出的输入性疟疾的发病率、临床特征及治疗反应。
对得克萨斯州休斯敦市1990年1月至1993年4月间出现的59例输入性疟疾病例进行回顾性病例系列研究。
59例患者被诊断为疟疾，其中12例是在移民美国前居住在疟疾流行地区时感染的，32例是原籍疟疾流行地区的美国居民，15例是原籍北美或欧洲的患者。只有12例患者接受过疟疾预防：8例服用氯喹，1例服用氯喹和氯胍（氯胍），2例服用氯喹和伯氨喹，1例间歇性服用甲氟喹。8例在服用氯喹后出现恶性疟原虫感染，1例在服用氯喹和氯胍后出现感染。2例尽管接受氯喹和伯氨喹预防仍出现间日疟原虫引起的疟疾。25例中，疟疾最初未被考虑为诊断。5例患者出现重症疾病（3例严重溶血，2例分别出现脑型疟疾和肾衰竭，1例出现成人呼吸窘迫综合征）。这5例中有4例最初被误诊。2例患者尽管接受静脉注射奎尼丁和换血治疗仍死亡。2例间日疟原虫感染患者尽管接受氯喹和伯氨喹疗程治疗仍多次复发。6例患者怀孕（包括1例死亡病例），发现1例先天性感染。6例患者1年多未出国旅行。
输入性疟疾频繁发生，通常是由于未使用适当的预防措施。延迟诊断和误诊很常见。尽管积极治疗，仍可见到重症疾病和死亡病例。耐药性持续传播，现在间日疟原虫和恶性疟原虫均出现耐药。
