Clinical spectrum of uncomplicated malaria in semi-immune Amazonians: beyond the " symptomatic " vs " asymptomatic " dichotomy
Clinical spectrum of uncomplicated malaria in semi-immune Amazonians: beyond the " symptomatic " vs " asymptomatic " dichotomy
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DOI：
10.1590/s0074-02762007005000051
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发表时间：
2007-06-01
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影响因子：
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通讯作者：
Ferreira, Marcelo U
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作者：
Silva-Nunes, Mônica da;Ferreira, Marcelo U
我们前瞻性分析了326例实验室确诊的无并发症疟疾感染（46.3%由间日疟原虫引起，35.3%由恶性疟原虫引起，18.4%由混合种感染引起），这些感染是在162名5-73岁的亚马逊农村人中诊断的。使用结构化问卷对13种症状（发热、寒战、出汗、头痛、肌痛、关节痛、腹痛、恶心、呕吐、头晕、咳嗽、呼吸困难和腹泻）进行评分。头痛（59.8%）、发热（57.1%）和肌痛（48.4%）是最常见的症状。96例（29.4%）发作无症状，所有这些都是在整个研究人群的横断面调查中诊断的（96.9%仅通过分子技术）。在93例未经治疗的无病毒感染中，只有10例在诊断后的两个月内出现症状。在230例有症状的疟疾病例中，52.6%的病例发热被认为是“严重的”，19.1%的病例没有发热，尽管存在其他症状。我们发现，在发热和其他临床症状的流行率和感知强度的显着差异，在诊断时的寄生虫负荷和患者的年龄，累积暴露于疟疾，最近的疟疾发病率，疟疾寄生虫的种类。这些因素都可能影响疟疾控制策略的有效性，这些策略是基于半免疫人群中发热受试者的主动或被动检测。
We analyzed prospectively 326 laboratory-confirmed, uncomplicated malarial infections (46.3% due to Plasmodium vivax, 35.3% due to P. falciparum, and 18.4% mixed-species infections) diagnosed in 162 rural Amazonians aged 5-73 years. Thirteen symptoms ( fever, chills, sweating, headache, myalgia, arthralgia, abdominal pain, nausea, vomiting, dizziness, cough, dyspnea, and diarrhea) were scored using a structured questionnaire. Headache (59.8%), fever (57.1%), and myalgia (48.4%) were the most frequent symptoms. Ninety-six (29.4%) episodes, all of them diagnosed during cross-sectional surveys of the whole study population (96.9% by molecular technique only), were asymptomatic. Of 93 symptom-less infections left untreated, only 10 became symptomatic over the next two months following diagnosis. Fever was perceived as "intense" in 52.6% of 230 symptomatic malaria episodes, with no fever reported in 19.1% episodes although other symptoms were present. We found significant differences in the prevalence and perceived intensity of fever and other clinical symptoms in relation to parasite load at the time of diagnosis and patient's age, cumulative exposure to malaria, recent malaria morbidity, and species of malaria parasite. These factors are all likely to affect the effectiveness of malaria control strategies based on active or passive detection of febrile subjects in semi-immune populations.