The clinical spectrum of severe imported falciparum malaria in the intensive care unit -: Report of 188 cases in adults
The clinical spectrum of severe imported falciparum malaria in the intensive care unit -: Report of 188 cases in adults
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DOI：
10.1164/rccm.200206-631oc
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发表时间：
2003-03-01
影响因子：
24.7
通讯作者：
Vachon, F
中科院分区：
文献类型：
--
作者：
Bruneel, F;Hocqueloux, L;Vachon, F
人们对非流行性工业化国家的严重输入性疟疾知之甚少。这项回顾性研究的目的是描述成人严重输入性疟疾的临床谱，并确定入院时存在的与重症监护病房死亡率相关的因素。这项回顾性研究评估了 1988 年至 1999 年间入住我们重症监护室的 188 名患有严重和/或复杂性输入性疟疾的患者。其中，93人为严格定义的严重疟疾，95人为较轻疟疾。平均年龄为 38 岁，51% 的患者是没有免疫力的白人，94% 的患者在撒哈拉以南非洲地区感染了恶性疟原虫，96% 的患者没有采取足够的抗疟药物预防措施。严重疟疾组的死亡率为 11%（10 名患者），而较轻的疟疾组没有患者死亡 (p = 0.002)。在双变量分析中，与严重疟疾组死亡相关的主要因素是简化急性生理学评分、休克、酸中毒、昏迷、肺水肿（p < 0.001）和凝血障碍（p = 0.002）。细菌合并感染并不罕见，并可能导致死亡。严重的输入性疟疾仍然是旅行者的主要威胁。在我们的人群中，最相关的世界卫生组织主要定义标准是昏迷、休克、肺水肿和酸中毒。
Little is known about severe imported malaria in nonendemic industrialized countries. The purpose of this retrospective study was to describe the clinical spectrum of severe imported malaria in adults and to determine factors that were present at admission and were associated with in-intensive care unit mortality. This retrospective study evaluated the 188 patients who were admitted to our intensive care unit in 1988-1999 with severe and/or complicated imported malaria. Among them, 93 had strictly defined severe malaria, and 95 had less severe malaria. The mean age was 38 years, 51% of patients were nonimmune whites, 94% acquired Plasmodium falciparum in sub-Saharan Africa, and 96% had taken inadequate antimalarial chemoprophylaxis. Mortality was 11% (10 patients) in the severe malaria group, whereas no patients died in the less severe malaria group (p = 0.002). In the bivariable analysis, the main factors associated with death in the severe malaria group were the Simplified Acute Physiology Score, shock, acidosis, coma, pulmonary edema (p < 0.001 for each), and coagulation disorders (p = 0.002). Bacterial coinfection is not infrequent and may contribute to death. Severe imported malaria remains a major threat to travelers. In our population, the most relevant World Health Organization major defining criteria were coma, shock, pulmonary edema, and acidosis.