Gaüzère B A, Roblin X, Blanc P, Xavierson G, Paganin F
Service de réanimation, Centre hospitalier départemental Félix Guyon, La Réunion, France.
Bull Soc Pathol Exot. 1998;91(1):95-8.
Located in the Indian ocean, Reunion island, a French overseas territory, is free of malaria since the 1960's. As malaria is still highly endemic in the neighbouring countries, imported cases are averaging 130 to 150 cases per year. From 1993 to 1996, about 483 cases of imported malaria were admitted in Reunion. Five severe complicated Plasmodium falciparum malaria cases occurring in non-immune persons, required further treatment in the intensive care unit (age 40 +/- 8 years, duration: 14.8 +/- 7.4, SAPS: 21 +/- 10). Three patients died. As short-stay travellers, patients were contaminated in Madagascar (4) and in Malawi (1) and presented with an associated pathology: alcohol and tobacco abuses (2 cases), AIDS (1 case). In all cases, chemoprophylaxis was either inadequate (chloroquine alone, 3 cases) or absent (2 cases) and the diagnosis and the appropriate treatment were delayed. Moreover, patients were either self-treating themselves, or initially refused to be admitted. Parasitemia was very high. Two patients died within an hour following their admission before diagnosis could be made and quinine treatment be initiated (rupture of the spleen, multiple organ failure). One patient died at day 7 (acute respiratory distress syndrome, renal failure). Two survived under respiratory assistance and hemodialysis and presented the usual intensive care complications (respiratory nosocomial infection, acute cholecystitis). In Réunion island, imported P. falciparum still accounts for a high rate of morbidity and few fatalities, despite a sophisticated curative health system. Delay in diagnosis and institution of an appropriate treatment is frequent in non-immune persons who develop fever and non-specific symptoms. It markedly increases the risk of complications and death from falciparum malaria as well as morbidity cofactors. Emphasis must be placed on appropriate information of health personnel and travellers.
留尼汪岛是法国的一个海外领地，位于印度洋，自20世纪60年代以来一直没有疟疾。由于邻国疟疾仍然高度流行，每年输入病例平均为130至150例。1993年至1996年，留尼汪岛收治了约483例输入性疟疾病例。5例发生在非免疫人群中的严重复杂性恶性疟原虫疟疾病例，需要在重症监护病房进一步治疗（年龄40±8岁，病程：14.8±7.4，简化急性生理学评分：21±10）。3例患者死亡。作为短期旅行者，患者在马达加斯加（4例）和马拉维（1例）感染，伴有相关病症：酗酒和吸烟（2例）、艾滋病（1例）。在所有病例中，化学预防要么不充分（仅使用氯喹，3例），要么未进行（2例），诊断和适当治疗均被延误。此外，患者要么自行治疗，要么最初拒绝入院。疟原虫血症非常高。2例患者在入院后1小时内死亡，未能作出诊断并开始奎宁治疗（脾破裂、多器官衰竭）。1例患者在第7天死亡（急性呼吸窘迫综合征、肾衰竭）。2例患者在呼吸辅助和血液透析下存活，并出现了常见的重症监护并发症（呼吸道医院感染、急性胆囊炎）。在留尼汪岛，尽管有完善的治疗性卫生系统，但输入性恶性疟原虫仍导致高发病率和少数死亡病例。在出现发热和非特异性症状的非免疫人群中，诊断和开始适当治疗的延误很常见。这显著增加了恶性疟并发症和死亡风险以及发病的辅助因素。必须重视对卫生人员和旅行者的适当宣传。
