Metha S R, Joshi V, Lazar A I
Medical Division, Army Hospital, Delhi.
J Assoc Physicians India. 1996 Jul;44(7):451-3.
32 cases (21 acute severe malaria and 11 chronic malaria syndrome), who developed unusual complications and/or manifestations are reported. The acute manifestations were unexplained tachypnoea 4, pulmonary oedema 5 and shock due to multiple organ dysfunction syndrome 3, melena 2 and E coli septicaemia in one. The other features were concomitant salmonellosis 2, meningitis 1, renal failure 3, hepatorenal syndrome 2, hepatitis like illness 7, neck stiffness with normal CSF 3, urticaria and subconiunctival haemorrhage 2 each, apyrexial spell with anaemia 4, thromocytopenia 3, and hypoglycaemia 3 (two pretreatment and one while on quinine in 5% glucose drip). The chronic syndrome noted were hyperreactive malaria syndrome (Tropical splenomegaly) 3, repeated haemolysis 2, chronic simple malaria with positive parasitaemia and normal Igm levels 4, and cerebellar ataxia with tremors 3. Bone marrow in these cases was hypercullular with increase plasma cells. Liver biopsy revealed lymphocytic infiltration. There was no case with permanent neurogical deficit. All patients with pulmonary oedema and multiple organ dysfunction died but chronic syndrome patients recovered fully. Early recoginition of atypical manifestation and prompt treatment will decrease the mortality and morbidity due to malaria.
报告了32例出现异常并发症和/或表现的病例（21例急性重症疟疾和11例慢性疟疾综合征）。急性表现包括原因不明的呼吸急促4例、肺水肿5例、多器官功能障碍综合征导致的休克3例、黑便2例以及1例大肠杆菌败血症。其他特征包括合并沙门菌病2例、脑膜炎1例、肾衰竭3例、肝肾综合征2例、肝炎样疾病7例、脑脊液正常但颈部僵硬3例、荨麻疹和结膜下出血各2例、无热发作伴贫血4例、血小板减少3例以及低血糖3例（2例在治疗前，1例在静脉滴注5%葡萄糖加奎宁时出现）。记录到的慢性综合征有高反应性疟疾综合征（热带脾肿大）3例、反复溶血2例、寄生虫血症阳性且免疫球蛋白M水平正常的慢性单纯性疟疾患者4例以及伴有震颤的小脑共济失调3例。这些病例的骨髓细胞增多，浆细胞增加。肝活检显示淋巴细胞浸润。无一例出现永久性神经功能缺损。所有肺水肿和多器官功能障碍患者均死亡，但慢性综合征患者完全康复。早期识别非典型表现并及时治疗将降低疟疾导致的死亡率和发病率。
