Gachot B, Ringwald P
Service de maladies infectiuses et tropicales, Hôpital de l'Institut Pasteur, Paris.
Rev Prat. 1998 Feb 1;48(3):273-8.
Falciparum malaria remains a major killer in developing countries, particularly for African children. The sequestration of parasitized erythrocytes in the deep microvasculature is mostly mediated by their cytoadherence to activated endothelium. Proinflammatory cytokines and particularly tumor necrosis factor contribute to severe disease but the pathophysiology of coma remains poorly understood. In young children, features of severe malaria include severe anemia, hypoglycemia and cerebral malaria. Half of the children with neurological impairment actually have raised intracranial pressure, and seizures are extremely common. Clinical respiratory distress usually reflects severe lactic acidosis. In non immune adults, pictures of severe sepsis with shock, acute renal failure and respiratory distress syndrome are common and often associated with bacterial coinfection. Although chemotherapy of malaria is challenged by the continuing evolution of antimalarial resistance, quinine remains the first-line drug for severe disease. The optimization of symptomatic management of severe malaria remains a major concern in developing countries.
恶性疟疾仍然是发展中国家的主要杀手，对非洲儿童而言尤为如此。被寄生红细胞在深部微血管中的滞留主要是通过其与活化内皮细胞的细胞黏附介导的。促炎细胞因子，尤其是肿瘤坏死因子，会导致严重疾病，但昏迷的病理生理学仍知之甚少。在幼儿中，重症疟疾的特征包括严重贫血、低血糖和脑型疟疾。半数有神经功能障碍的儿童实际上存在颅内压升高，癫痫发作极为常见。临床呼吸窘迫通常反映严重的乳酸酸中毒。在非免疫的成年人中，伴有休克、急性肾衰竭和呼吸窘迫综合征的严重脓毒症表现很常见，且常与细菌合并感染有关。尽管疟疾化疗因抗疟耐药性的不断演变而面临挑战，但奎宁仍然是重症疾病的一线药物。在发展中国家，优化重症疟疾的对症治疗仍然是一个主要问题。
