Malaria
Malaria
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DOI：
10.1016/s0140-6736(13)60024-0
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发表时间：
2014-02-22
期刊：
影响因子：
168.9
通讯作者：
Dondorp, Arjen M.
中科院分区：
文献类型：
--
作者：
White, Nicholas J.;Pukrittayakamee, Sasithon;Dondorp, Arjen M.
虽然全球发病率和死亡率已大幅下降，但疟疾这种寄生虫感染红细胞的疾病每天仍造成大约2 000人死亡，其中大多数是非洲儿童。减少的主要原因有两个：使用驱虫蚊帐的人数增加和高效青蒿素综合疗法的供应增加。在大型试验中，与奎宁相比，注射用青蒿琥酯（一种青蒿素衍生物）使非洲的严重疟疾死亡率降低了22.5%，使亚洲的严重疟疾死亡率降低了34.7%，而预防性干预措施一直不成功。快速检测是疟疾诊断显微镜的重要补充。在非洲越来越多地采用化学预防战略，特别是在怀孕期间间歇性使用磺胺嘧啶-乙胺嘧啶治疗，以及在整个萨赫勒以南地区，在雨季期间每月对3个月至5岁的儿童使用阿莫地喹-磺胺嘧啶-乙胺嘧啶。消灭疟疾的热情重新出现。这一雄心勃勃但值得称赞的目标面临着许多挑战，包括全球经济衰退，消除间日疟的困难，一些按蚊对拟除虫菊酯的耐药性，以及东南亚恶性疟原虫对青蒿素的耐药性。本文就疟疾的流行病学、临床特点、病理、预防和治疗等方面进行综述。
Although global morbidity and mortality have decreased substantially, malaria, a parasite infection of red blood cells, still kills roughly 2000 people per day, most of whom are children in Africa. Two factors largely account for these decreases; increased deployment of insecticide-treated bednets and increased availability of highly effective artemisinin combination treatments. In large trials, parenteral artesunate (an artemisinin derivative) reduced severe malaria mortality by 22.5% in Africa and 34.7% in Asia compared with quinine, whereas adjunctive interventions have been uniformly unsuccessful. Rapid tests have been an important addition to microscopy for malaria diagnosis. Chemopreventive strategies have been increasingly deployed in Africa, notably intermittent sulfadoxine-pyrimethamine treatment in pregnancy, and monthly amodiaquine-sulfadoxine-pyrimethamine during the rainy season months in children aged between 3 months and 5 years across the sub-Sahel. Enthusiasm for malaria elimination has resurfaced. This ambitious but laudable goal faces many challenges, including the worldwide economic downturn, difficulties in elimination of vivax malaria, development of pyrethroid resistance in some anopheline mosquitoes, and the emergence of artemisinin resistance in Plasmodium falciparum in southeast Asia. We review the epidemiology, clinical features, pathology, prevention, and treatment of malaria.