Childhood malaria in a region of unstable transmission and high human immunodeficiency virus prevalence
Childhood malaria in a region of unstable transmission and high human immunodeficiency virus prevalence
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DOI：
10.1097/01.inf.0000101188.95433.60
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发表时间：
2003-12-01
影响因子：
3.6
通讯作者：
Gilks, CF
中科院分区：
文献类型：
--
作者：
Grimwade, K;French, N;Gilks, CF
背景资料。疟疾和艾滋病毒是撒哈拉以南非洲的重要儿科问题。目前还不确定艾滋病毒相关的免疫抑制和疟疾在儿童中如何相互作用。我们的目的是描述南非夸祖鲁-纳塔尔HLabisa地区儿童的HIV状况、表现和疟疾结局之间的关系。HLabisa地区是HIV高发区，恶性疟原虫传播不稳定。用快速抗原测试对连续发烧的儿童进行疟疾筛查。在给予同意后，记录临床数据，并采集血点进行HIV抗体检测。病例按国家指导方针处理。在663名儿童中诊断出疟疾，其中10.1%的儿童艾滋病毒抗体阳性。半定量的无性和有性期寄生虫血症密度与HIV状况无关。总共有161名儿童住院；19名(12%)1岁以下儿童；41名(25%)患有严重/复杂疟疾。HIV抗体阳性儿童病情严重的比例明显高于非HIV感染儿童(P=0.05)，尤其是1岁以下昏迷儿童(P=0.02)和低血糖儿童(P=0.05)。接受静脉注射抗生素与严重疾病有关(优势比为3.0；95%可信区间为1.3至6.7)，而低白细胞计数(
Background. Malaria and HIV are important pediatric problems in sub-Saharan Africa. It is uncertain how HIV-related immunosuppression and malaria interact in children. We aimed to describe associations among HIV status, presentation and outcome from malaria in children from Hlabisa district, KwaZulu-Natal, South Africa, a region of high HIV prevalence and unstable Plasmodium falciparum transmission.Methods. Consecutive febrile children were screened for malaria with a rapid antigen test. After consent was given, clinical data were recorded, and blood spots were obtained for HIV antibody testing. Cases were managed according to national guidelines.Results. Malaria was diagnosed in 663 children, of whom 10.1% were HIV antibody-positive. Semi-quantitative asexual and sexual stage parasitemia densities were unrelated to HIV status. Overall 161 children were hospitalized; 19 (12%) were < 1 year old; and 41 (25%) had severe/ complicated malaria. Severe disease presented more frequently in HIV antibody-positive than in HIV-uninfected children (P = 0.05), particularly in those >1 year old with coma (P = 0.02) and hypoglycemia (P = 0.05). Receiving parenteral antibiotics was associated with severe disease (odds ratio, 3.0; 95% confidence interval, 1.3 to 6.7) whereas a low white blood cell count (