Imported malaria: Prospective analysis of problems in diagnosis and management
Imported malaria: Prospective analysis of problems in diagnosis and management
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DOI：
10.1086/514616
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发表时间：
1998-07-01
影响因子：
11.8
通讯作者：
Keystone, JS
中科院分区：
文献类型：
--
作者：
Kain, KC;Harrington, MA;Keystone, JS
在许多国家，输入性疟疾是一个日益严重的问题。本研究的目的是前瞻性地评价通过主动监测发现的输入性疟疾病例的诊断和治疗。还将群落水平的显微镜诊断与参考显微镜和盲法分子诊断方法进行了比较。大多数感染疟疾的旅行者在旅行前都寻求过医生的建议;然而，只有11%的人使用了推荐的药物预防，只有17%的人使用了昆虫保护措施。59%的病例最初漏诊疟疾。基于社区的显微镜诊断在64%的病例中提供了不正确的物种鉴定。在发病后，治疗前的平均延迟时间为恶性疟疾7.6天，间日疟5.1天。总体而言，7.5%的恶性疟原虫感染患者发展为严重疟疾，11%的病例治疗失败。到没有热带医学专业知识的中心就诊的患者接受的治疗不理想。提高对疟疾的认识、诊断和治疗对于预防旅行者发病和死亡至关重要。
Imported malaria is an increasing problem in many countries. The objective of this study was to prospectively evaluate the diagnosis and treatment of imported malaria cases identified by active surveillance. Microscopic diagnosis at the community level was also compared to reference microscopic and blinded molecular diagnostic methods. Most travelers who acquired malaria had sought pretravel advice from a physician; however, only 11% used recommended chemoprophylaxis and only 17% used insect protection measures. The diagnosis of malaria was initially missed in 59% of cases. Community-based microscopic diagnosis provided incorrect species identification in 64% of cases. After presentation, the average delay before treatment was 7.6 days for falciparum malaria and 5.1 days for vivax malaria. Overall, 7.5% of Plasmodium falciparum-infected patients developed severe malaria, and in 11% of all cases therapy failed. Patients who present to a center without expertise in tropical medicine receive suboptimal treatment. Improvements in recognition, diagnosis, and treatment of malaria are essential to prevent morbidity and death among travelers.