Espinosa G, Tortajada C, Gascón J, Miquel R, Nicolás J M, Nadal P, Corachán M
Servicio de Medicina Interna General, Hospital Clínic i Provincial de Barcelona.
Rev Clin Esp. 1997 Sep;197(9):631-4.
In the last few years a considerable number of imported malaria has been reported in Spain, probably due the increased tourism to areas with endemic malaria, particularly with P. falciparum. This is the species more frequently associated with severe complications and the only one capable of causing cerebral malaria. In this report we review five cases of malaria which required intensive care because of their severity. None of the patients had received chemoprophylaxis. In all cases the admission criterion to the intensive care unit was the organic failure of one or more systems (renal failure and disseminated intravascular coagulation [DIC] mainly) or the presence of changes in the central nervous system. Parasitemia at admission was higher than 5% in all patients. One patient died on account of cerebral malaria. Only one patient had severe complications not directly associated with malaria. In patients who already have severity criteria, a negative parasitemia test during the clinical course does not necessarily implies a clinical improvement nor does it exclude the emergence of complications. On the other hand, a low parasitemic degree is never a contraindication for admission to the intensive care unit when severity criteria are present.
在过去几年里，西班牙报告了相当数量的输入性疟疾病例，这可能是由于前往疟疾流行地区（特别是恶性疟流行地区）的旅游业增加所致。恶性疟是更常与严重并发症相关的疟原虫种类，也是唯一能够引发脑型疟疾的疟原虫种类。在本报告中，我们回顾了5例因病情严重而需要重症监护的疟疾病例。所有患者均未接受过化学预防。在所有病例中，入住重症监护病房的标准是一个或多个系统出现器官功能衰竭（主要是肾衰竭和弥散性血管内凝血[DIC]）或存在中枢神经系统变化。所有患者入院时的疟原虫血症均高于5%。1例患者死于脑型疟疾。只有1例患者出现了与疟疾无直接关联的严重并发症。对于已经有病情严重标准的患者，临床过程中疟原虫血症检测呈阴性并不一定意味着临床病情改善，也不能排除并发症的出现。另一方面，当存在病情严重标准时，疟原虫血症程度低绝不是入住重症监护病房的禁忌证。
