Clinical review: Severe malaria.
Clinical review: Severe malaria.
复制标题
DOI：
10.1186/cc2183
复制
发表时间：
2003-08
期刊：
影响因子：
--
通讯作者：
Prabhu RM
中科院分区：
文献类型：
--
作者：
Trampuz A;Jereb M;Muzlovic I;Prabhu RM
疟疾是一种医疗紧急情况，因为它可能迅速发展为并发症和死亡，而没有及时和适当的治疗。严重的疟疾几乎完全是由恶性疟原虫引起的。输入性疟疾的发病率正在上升，尽管在重症监护和抗疟治疗方面取得了进展，但病死率仍然很高。临床恶化通常出现在发烧后3-7天。并发症涉及神经、呼吸、肾脏和/或造血系统。代谢性酸中毒和低血糖是常见的全身并发症。静脉注射奎宁和奎尼丁是严重恶性疟疾初期治疗中最广泛使用的药物，而青蒿素衍生物目前被推荐用于奎宁耐药病例。一旦患者临床稳定并能够吞咽，应给予口服治疗。应将血管内容量维持在足以进行充分全身灌注的最低水平，以防止发生急性呼吸窘迫综合征。肾脏替代治疗应尽早开始。对于重症疟疾和高寄生虫血症的病人，建议进行换血治疗。对于早期诊断，最重要的是要考虑到疟疾在疟疾流行地区旅行史的每一个发热患者。
Malaria represents a medical emergency because it may rapidly progress to complications and death without prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria is increasing and the case fatality rate remains high despite progress in intensive care and antimalarial treatment. Clinical deterioration usually appears 3–7 days after onset of fever. Complications involve the nervous, respiratory, renal, and/or hematopoietic systems. Metabolic acidosis and hypoglycemia are common systemic complications. Intravenous quinine and quinidine are the most widely used drugs in the initial treatment of severe falciparum malaria, whereas artemisinin derivatives are currently recommended for quinine-resistant cases. As soon as the patient is clinically stable and able to swallow, oral treatment should be given. The intravascular volume should be maintained at the lowest level sufficient for adequate systemic perfusion to prevent development of acute respiratory distress syndrome. Renal replacement therapy should be initiated early. Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and high parasitemia. For early diagnosis, it is paramount to consider malaria in every febrile patient with a history of travel in an area endemic for malaria.
登录
查看更多内容
DOI：
10.1164/rccm.200206-631oc
发表时间：
2003-03-01
影响因子：
24.7
作者：
Bruneel, F;Hocqueloux, L;Vachon, F
通讯作者：
Vachon, F
影响因子：
8.8
作者：
Dellinger, RP;Zimmerman, JL;Papadakos, P
通讯作者：
Papadakos, P
影响因子：
11.8
作者：
Kain, KC;Harrington, MA;Keystone, JS
通讯作者：
Keystone, JS
影响因子：
38.9
作者：
Kellum, JA;Angus, DC;Linde-Zwirble, WT
通讯作者：
Linde-Zwirble, WT
影响因子：
158.5
作者：
Anzueto, A;Baughman, RP;Pattishall, EN
通讯作者：
Pattishall, EN