Kain K C, Harrington M A, Tennyson S, Keystone J S
Department of Medicine, University of Toronto, Ontario, Canada.
Clin Infect Dis. 1998 Jul;27(1):142-9. doi: 10.1086/514616.
Imported malaria is an increasing problem in many countries. The objective of this study was to prospectively evaluate the diagnosis and treatment of imported malaria cases identified by active surveillance. Microscopic diagnosis at the community level was also compared to reference microscopic and blinded molecular diagnostic methods. Most travelers who acquire malaria had sought pretravel advice from a physician; however, only 11% used recommended chemoprophylaxis and only 17% used insect protection measures. The diagnosis of malaria was initially missed in 59% of cases. Community-based microscopic diagnosis provided incorrect species identification in 64% of cases. After presentation, the average delay before treatment was 7.6 days for falciparum malaria and 5.1 days for vivax malaria. Overall, 7.5% of Plasmodium falciparum-infected patients developed severe malaria, and in 11% of all cases therapy failed. Patients who present to a center without expertise in tropical medicine receive suboptimal treatment. Improvements in recognition, diagnosis, and treatment of malaria are essential to prevent morbidity and death among travelers.
输入性疟疾在许多国家正成为一个日益严重的问题。本研究的目的是前瞻性评估通过主动监测发现的输入性疟疾病例的诊断和治疗情况。还将社区层面的显微镜诊断与参考显微镜诊断及盲法分子诊断方法进行了比较。大多数感染疟疾的旅行者曾向医生寻求过旅行前建议；然而，只有11%的人使用了推荐的化学预防措施，只有17%的人采取了防蚊措施。59%的病例最初漏诊了疟疾。基于社区的显微镜诊断在64%的病例中提供了错误的物种鉴定。就诊后，恶性疟的平均治疗延迟时间为7.6天，间日疟为5.1天。总体而言，7.5%的恶性疟感染患者发展为重症疟疾，11%的所有病例治疗失败。前往没有热带医学专业知识的中心就诊的患者接受的治疗并不理想。改善疟疾的识别、诊断和治疗对于预防旅行者的发病和死亡至关重要。
