Clinical and laboratory predictors of imported malaria in an outpatient setting:: An aid to medical decision making in returning travelers with fever
Clinical and laboratory predictors of imported malaria in an outpatient setting:: An aid to medical decision making in returning travelers with fever
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DOI：
10.4269/ajtmh.2002.66.481
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发表时间：
2002-05-01
影响因子：
3.3
通讯作者：
Genton, B
中科院分区：
文献类型：
--
作者：
D'Acremont, V;Landry, P;Genton, B
当临床上强烈怀疑疟疾但实验室确认无法立即获得或呈阴性时，没有基于证据的信息可以指导临床医生对回国旅行者进行推定治疗。对寻求发烧治疗的旅行者或移民进行了一项前瞻性研究，以确定疟原虫寄生虫血症的临床和实验室预测因素。总共收集了 336 份问卷（97 名疟疾病例患者和 239 名对照者）。多因素回归分析显示，预防不充分、出汗、无腹痛、体温大于或等于38℃、一般健康状况不佳、脾脏肿大、白细胞小于或等于10 x 10(3)/L、血小板<150 x 10(3)/L、血红蛋白<12 g/dL、嗜酸性粒细胞小于或等于5%与寄生虫血症相关。脾脏肿大诊断疟疾的阳性似然比最高（13.6），其次是血小板减少症（11.0）。脾肿大的检测后疟疾概率为 85%，血小板减少症的概率为 82%。因此，快速评估可以帮助决定是否应该给予推定治疗，特别是当寄生虫学检查结果无法立即获得或不确定时。
No evidence-based information exists to guide clinicians for giving presumptive treatment to returning travelers when malaria is strongly suspected on clinical grounds but laboratory confirmation is not immediately available or is negative. A prospective study was conducted in travelers or migrants who sought care for fever to identify clinical and laboratory predictors of Plasmodium parasitemia. A total of 336 questionnaires were collected (97 malaria case patients and 239 controls). Multivariate regression analysis showed inadequate prophylaxis, sweating, no abdominal pain, temperature greater than or equal to 38degreesC, poor general health, enlarged spleen, leucocytes less than or equal to 10 x 10(3)/L, platelets < 150 x 10(3)/L, hemoglobin < 12 g/dL, and eosinophils less than or equal to 5% to be associated with parasitemia. Enlarged spleen had the highest positive likelihood ratio for a diagnosis of malaria (13.6), followed by thrombopenia (11.0). Posttest probabilities for malaria were 85% with enlarged spleen and 82% with thrombopenia. A rapid assessment can thus help to decide whether a presumptive treatment should be given or not, especially when the results of the parasitological examination are not immediately available or are uncertain.