Falciparum malaria after splenectomy: a prospective controlled study of 33 previously splenectomized Malawian adults
Falciparum malaria after splenectomy: a prospective controlled study of 33 previously splenectomized Malawian adults
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DOI：
10.1016/j.trstmh.2005.03.008
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发表时间：
2005-11-01
影响因子：
2.2
通讯作者：
Molyneux, M
中科院分区：
文献类型：
--
作者：
Bach, O;Baier, M;Molyneux, M
我们确定了33名马拉维人，他们因创伤性损伤接受了全脾切除术。我们对这些患者和33名对照患者进行了为期1年的临床和寄生虫学检查。脾切除术患者(S)在就诊前一个月内抱怨发热症状的可能性是对照组(C)的2.5倍（P < 0.0001）。他们患恶性疟原虫寄生虫血症的可能性几乎是对照组的两倍（S: 176/283人次；C: 86/262; P < 0.0001）。在脾切除术个体中，寄生虫血症更可能与发热症状相关（S: 104/176, 59%; C: 24/86, 28%; P < 0.0001）。脾切除组有3例死亡（2例非疟疾，1例原因不明），对照组无一例死亡。寄生虫密度达到显著较高的水平，成熟的寄生虫阶段更常见于外周血，在无脾个体。在部分免疫人群中，无脾个体患疟疾感染和疾病的风险增加。在没有定期检查和及时治疗的更大群体中，可能会增加危及生命的疟疾的风险。在恶性疟原虫地方性传播的地区，应尽可能避免脾切除术。(c) 2005年Elsevier Ltd代表皇家热带医学与卫生学会出版。
We identified 33 Malawians who had undergone total splenectomy for traumatic injury. We reviewed these and 33 controls by clinical and parasitological examination monthly for 1 year. Splenectomized patients (S) were 2.5 times as likely as controls (C) to complain about febrile symptoms during the month preceding a visit (P < 0.0001). They were nearly twice as likely as controls to have Plasmodium falciparum parasitaemia (S: 176/283 person visits; C: 86/262; P < 0.0001). Parasitaemia was more likely to be associated with febrile symptoms in splenectomized individuals (S: 104/176, 59%; C: 24/86, 28%; P < 0.0001). There were three deaths (two non-malarial, one unexplained) among splenectomized subjects and none in the control group. Parasite densities reached significantly higher levels, and mature parasite stages were more often seen in the peripheral blood, in asplenic individuals. In a partially immune population, asplenic individuals are at increased risk of malarial infections and illness. In a larger group without the benefit of regular review and prompt therapy, there may be an increased risk of life-threatening malaria. Splenectomy should be avoided when possible in an area with endemic transmission of P falciparum. (c) 2005 Published by Elsevier Ltd on behalf of Royal Society of Tropical Medicine and Hygiene.