Does This Patient Have Malaria?
Does This Patient Have Malaria?
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DOI：
10.1001/jama.2010.1578
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发表时间：
2010-11-10
影响因子：
120.7
通讯作者：
Juliano, Jonathan J.
中科院分区：
文献类型：
--
作者：
Taylor, Steve M.;Molyneux, Malcolm E.;Juliano, Jonathan J.
疟疾通常感染热带地区的居民和旅行者。众所周知，感染的临床特征是非特异性的，但尚未得到全面的评估。目的系统回顾和综合与临床表现对疟疾流行地区和从流行地区归来的旅行者诊断预测价值有关的资料。数据来源、研究选择和数据提取检索MEDLINE和EMBASE数据库（1950- 2010年7月），以确定用英语发表的地方性和“输入性”（在旅行中获得）疟疾的研究。从参考文献列表中确定了其他研究。纳入了有疑似急性疟疾患者（通常因为发烧）的研究，并将有无临床发现与血液涂片证实进行了比较。两位作者独立确定了研究，评估了研究质量，并提取了患者群体、结果评估和临床发现的数据。审稿人之间的分歧通过协商一致解决。确定了14项符合审查标准的地方性疟疾研究。个体症状的诊断效用有限，但脾肿大（总似然比[LR]， 3.3； 95%置信区间[CI]， 2.0-4.7）或肝肿大（总似然比[LR]， 2.4； 95%置信区间[CI]， 1.6-3.6）的存在使疟疾的可能性更大。这些发现的组合可以影响疟疾的可能性，但是它们的效果因环境而异。确定了7项关于输入性疟疾的研究。发热（LR, 5.1; 95% CI, 4.9-5.3）、脾肿大（总体LR， 6.5; 95% CI, 3.9-11.0）、高胆红素血症（LR, 7.3; 95% CI, 5.5-9.6）或血小板减少症（总体LR， 5.6; 95% CI, 4.1-7.5）的存在使疟疾更容易发生。结论：在流行地区，脾肿大和肝肿大的存在增加了疟疾的可能性，但个体发现的效用有限，不能可靠地排除疟疾；综合这些发现可能有助于对患者的风险进行分层。对于返乡的旅行者，临床评估可提供实质性的诊断益处，尽管所有患者仍需要实验室检测，因为疟疾可迅速致命。《美国医学协会杂志》上。2010年;304 (18): 2048 - 2056 www.jama.com
Context Malaria commonly infects residents of and travelers to tropical regions. The clinical features of infection are notoriously nonspecific but have not been comprehensively evaluated.Objective To systematically review and synthesize data related to the predictive value of clinical findings for the diagnosis of malaria in endemic areas and in travelers returning from endemic areas.Data Sources, Study Selection, and Data Extraction The databases of MEDLINE and EMBASE (1950-July 2010) were searched to identify studies published in the English language of endemic and "imported" (acquired during travel) malaria. Additional studies were identified from reference lists. Studies were included that had patients suspected of having acute malaria (usually because of fever) and compared the presence or absence of clinical findings with blood smear confirmation. Two authors independently identified studies, appraised study quality, and extracted data on the patient population, outcome assessment, and clinical findings. Differences between reviewers were resolved by consensus.Data Synthesis Fourteen studies for endemic malaria were identified that met review criteria. Individual symptoms are of limited diagnostic utility but presence of splenomegaly (summary likelihood ratio [LR], 3.3; 95% confidence interval [CI], 2.0-4.7) or hepatomegaly (summary LR, 2.4; 95% CI, 1.6-3.6) make malaria more likely. Combinations of findings can affect the likelihood of malaria, but their performance varies by setting. Seven studies of imported malaria were identified. The presence of fever (LR, 5.1; 95% CI, 4.9-5.3), splenomegaly (summary LR, 6.5; 95% CI, 3.9-11.0), hyperbilirubinemia (LR, 7.3; 95% CI, 5.5-9.6), or thrombocytopenia (summary LR, 5.6; 95% CI, 4.1-7.5) make malaria more likely.Conclusions In endemic areas, the likelihood of malaria is increased by the presence of splenomegaly and hepatomegaly but individual findings are of limited utility and cannot reliably exclude malaria; combinations of findings may be useful to stratify risk in patients. In returning travelers, the clinical assessment can provide substantial diagnostic benefit, although all patients still require laboratory testing because malaria can be rapidly fatal. JAMA. 2010;304(18):2048-2056 www.jama.com