Over-diagnosis and co-morbidity of severe malaria in African children: A guide for clinicians
Over-diagnosis and co-morbidity of severe malaria in African children: A guide for clinicians
复制标题
DOI：
10.4269/ajtmh.2007.77.6
复制
发表时间：
2007-12-01
影响因子：
3.3
通讯作者：
Berkley, James A.
中科院分区：
文献类型：
--
作者：
Gwer, Samson;Newton, Charles R. J. C.;Berkley, James A.
严重疟疾在临床上与其他严重发热性疾病相似。然而，在流行地区，寄生虫血症的寄生虫学确认往往无法获得或不可靠。疟疾镜检假阳性很常见。在不存在寄生虫血症的情况下仅治疗疟疾的最重要后果是无法解决其他危及生命的疾病。多达三分之一具有严重疟疾临床特征的儿童检测到侵袭性细菌感染，但也有少数儿童的疟疾结果呈阴性。即使在真正被寄生虫感染的儿童中，严重的疾病也并不总是由流行地区的疟疾引起。我们认为，对于患有表明疟疾和危及生命的疾病的儿童，常规使用肠外抗生素是必要的，因为侵袭性细菌感染可能未被充分确定，并且与死亡率增加有关。对已发表的有关艾滋病毒感染和营养不良共病的数据进行了审查。结构化的评估和护理方法至关重要，并且在很大程度上独立于潜在的病因。
Severe malaria is clinically similar to other severe febrile illnesses. However, in endemic areas, parasitelogical confirmation of parasitemia is often unavailable or unreliable. False-positive malaria microscopy is common. The most important consequence of treating only for malaria when no parasitemia exists is failure to address other life-threatening conditions. Invasive bacterial infections are detected in up to one third of children with clinical features of severe malaria but a slide with results negative for malaria. Even among genuinely parasitized children, severe illness is not always due to malaria in endemic areas. We believe that routine use of parenteral antibiotics among children with a slide that indicates malaria and life-threatening disease is warranted because invasive bacterial infections are likely to be under-ascertained and are associated with increased mortality. Published data on co-morbidity with HIV infection and malnutrition are reviewed. A structured approach to assessment and care is essential, and is largely independent of underlying etiology.