An outbreak of malaria in US Army Ranges returning from Afghanistan
An outbreak of malaria in US Army Ranges returning from Afghanistan
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DOI：
10.1001/jama.293.2.212
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发表时间：
2005-01-12
影响因子：
120.7
通讯作者：
Petruccelli, BP
中科院分区：
文献类型：
--
作者：
Kotwal, RS;Wenzel, RB;Petruccelli, BP
背景与众多的美国军事人员目前部署在世界各地，军事和民用卫生保健专业人员可能会遇到进口疟疾从这个population.Objective识别疟疾在美国陆军人员部署到一个战斗区。设计，设置和患者的情况下，在美国陆军卫生保健系统系列。在2002年6月至9月期间部署到阿富汗东部的一支725人的突击队中，共发现38例疟疾病例。主要结果测量疟疾病例的识别和士兵自我报告的抗疟措施的依从性。结果共有38名患者感染间日疟原虫，发病率为52.4例/1000名士兵。从疟疾流行区返回后，确诊时间中位数为233天（范围1-339天），其他实验室检查结果显示贫血和血小板减少。1例患者在初次发作时并发急性呼吸窘迫综合征，复发时并发自发性气胸。该病例占研究人群2例复发病例中的1例。根据对72%（521/725）的工作组进行的匿名部署后调查，自我报告的每周药物预防依从率为52%，（部署后）化学预防，31%每周和终末化学预防，82%用氯菊酯处理制服，结论间日疟原虫可延迟临床表现。症状通常是模糊的，但疟疾应包括在从流行地区返回的士兵的鉴别诊断。对预防措施的遵守情况不佳可能导致疟疾爆发。
Context With numerous US military personnel currently deployed throughout the world, military and civilian health care professionals may encounter imported malaria from this population.Objective To identify malaria in US Army personnel deployed to a combat zone.Design, Setting, and Patients Case series in the US Army health care system. A total of 38 cases of malaria were identified in a 725-man Ranger Task Force that deployed to eastern Afghanistan between June and September 2002.Main Outcome Measures Identification of malaria cases and soldiers' self-report of compliance with antimalarial measures.Results A total of 38 patients were infected with Plasmodium vivax, yielding an attack rate of 52.4 cases per 1000 soldiers. Diagnosis was confirmed a median of 233 days (range, 1-339 days) after return from the malaria endemic region, with additional laboratory findings noting anemia and thrombocytopenia. One case was complicated with acute respiratory distress syndrome during the patient's primary attack and a spontaneous pneumothorax during relapse. This case accounted for 1 of 2 relapse cases in the study population. From an anonymous postdeployment survey of 72% (521/725) of the task force, the self-reported compliance rate was 52% for weekly chemoprophylaxis, 41% for terminal (postdeployment) chemoprophylaxis, 31% for both weekly and terminal chemoprophylaxis, 82% for treating uniforms with permethrin, and 29% for application of insect repellent.Conclusions Delayed clinical presentation can occur with P vivax. Symptoms are often vague, but malaria should be included in the differential diagnosis for soldiers returning from an endemic region. Suboptimal compliance with preventive measures can result in a malaria outbreak.