The epidemiology of severe malaria in an area of low transmission in Thailand
The epidemiology of severe malaria in an area of low transmission in Thailand
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DOI：
10.1016/s0035-9203(97)90066-3
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发表时间：
1997-05-01
影响因子：
2.2
通讯作者：
White, N
中科院分区：
文献类型：
--
作者：
Luxemburger, C;Ricci, F;White, N
在泰国西部边境的克伦族社区生活的诱发因素，临床表现和严重疟疾的结果进行了为期2年的研究。这是一个疟疾传播率低的地区（大约每人每年一个感染者），无症状的疟疾很少见。在4728人中，有2573例间日疟，无一例死亡，有5776例恶性疟，其中303人（5%）患有严重疟疾，11人（0.2%）死亡，病死率为1.9/1000（95%置信区间[CI] 1.0-3.3）。患上严重疟疾和死亡的风险随着年龄的增长而稳步下降。重症疟疾的临床特征在儿童和成人之间存在差异。贫血在5岁以下儿童中比在年龄较大的儿童和成人中更常见，而脑受累的发病率随着年龄的增长而增加。重度疟疾在孕妇中的发生率是非孕妇的3倍（95%CI 1.4-6.2），但在恶性疟原虫和间日疟原虫混合感染的患者中的发生率比仅感染恶性疟原虫的患者低4.2倍（95%CI 2.3-7.9），表明间日疟原虫可能减轻恶性疟原虫疟疾的严重程度。
The predisposing factors, clinical presentation, and outcome of severe malaria in a Karen community living on the western border of Thailand were studied over a period of 2 years. This was an area of low malaria transmission (approximately one infection per person per year), where asymptomatic malaria is unusual. In a population of 4728 persons, who had good access to facilities for malaria diagnosis and treatment, there were 2573 cases of vivax malaria, none of whom died, and there were 5776 cases of falciparum malaria, 303 (5%) of whom had severe malaria and 11 (0.2%) of whom died-a case fatality rate of 1.9 per 1000 (95% confidence interval [CI] 1.0-3.3). The risks of developing severe malaria and dying declined steadily with age. The clinical features of severe malaria differed between children and adults. Anaemia was more common in children under 5 years old than in older children and adults, whereas the incidence of cerebral involvement increased with age. Severe malaria was 3 times (95% CI 1.4-6.2) more common in pregnant than in non-pregnant women, but was 4.2 times (95% CI 2.3-7.9) less common in patients with mixed Plasmodium falciparum and P. vivax infections than in those with P. falciparum alone, suggesting that P. vivax may attentuate the severity of P. falciparum malaria.