Allen S J, O'Donnell A, Alexander N D, Clegg J B
Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK.
QJM. 1996 Oct;89(10):779-88. doi: 10.1093/qjmed/89.10.779.
The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.
对巴布亚新几内亚马当医院收治的489例疟疾患儿的重症恶性疟临床特征及死亡危险因素进行了研究。疟疾最常见的严重表现为严重贫血（22%）和昏迷（16%）。严重贫血患儿比昏迷患儿年龄小（中位年龄分别为2.2岁和3.7岁），入院前患病时间更长（分别为中位7天和4天）。尽管马当疟疾患儿昏迷的临床特征与非洲患儿报道的特征非常相似，但死亡率较低（分别为8%和17 - 25%）。总体而言，17例（3.5%）患儿死亡，大多数在入院后12小时内死亡。血浆乳酸水平高（≥5 mmol/L）很常见（20%），是多元回归分析中死亡的主要预测因素。血浆肌酐升高和血浆碳酸氢盐降低也是死亡的独立预测因素。昏迷不能预测死亡，尽管深度昏迷的患儿中有很大比例死亡。对疟疾患儿酸中毒原因的研究是一个高度优先的研究课题。鉴于许多患儿入院后至死亡的时间间隔很短，必须强调在地区卫生诊所和中心医院预防或早期识别及治疗酸中毒。
