CLINICAL-FEATURES AND OUTCOME OF SEVERE MALARIA IN GAMBIAN CHILDREN
CLINICAL-FEATURES AND OUTCOME OF SEVERE MALARIA IN GAMBIAN CHILDREN
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DOI：
10.1093/clinids/21.3.577
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发表时间：
1995-09-01
影响因子：
11.8
通讯作者：
WHITE, NJ
中科院分区：
文献类型：
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作者：
WALLER, D;KRISHNA, S;WHITE, NJ
本文对1985年至1989年间180例冈比亚儿童重症恶性疟疾的临床和实验室特点进行了研究。在180名儿童中，118名(66%)出现癫痫发作，77名(43%)患有脑型疟疾，35名(20%)入院后出现癫痫发作，29名(16%)出现低血糖，27名(15%)死亡。呼吸窘迫是致命结局的常见先兆。死亡患者和存活患者在入院时血液中寄生虫计数、红细胞压积和开放脑脊液压力方面的差异不显著。多元Logistic回归模型确定神经系统状态(昏迷，尤其是与伸肌姿势相关)、外周血片上寄生虫发育阶段、脉搏或呼吸频率、低血糖和高乳酸血症(血浆乳酸水平，>；5 mmol/L)作为死亡结果的独立指标，肝和肾功能障碍的生化证据是预后不良的另一个标志，但与成人严重疟疾相比，这些患有严重疟疾的儿童没有发生急性肾功能衰竭。
The clinical and laboratory features of severe falciparum malaria in 180 Gambian children were studied between 1985 and 1989. Of the 180 children, 118 (66%) presented with seizures, 77 (43%) had cerebral malaria, 35 (20%) had witnessed seizures after admission, 29 (16%) were hypoglycemic, and 27 (15%) died. Respiratory distress was a common harbinger of a fatal outcome. The differences in admission parasite counts in the blood, hematocrit, and opening cerebrospinal pressures for patients who died and survivors were not significant. A multiple logistic regression model identified neurological status (coma, particularly if associated with extensor posturing), stage of parasite development on the peripheral blood film, pulse rate of >150 or respiratory rate of >50, hypoglycemia, and hyperlactatemia (plasma lactate level, >5 mmol/L) as independent indicators of a fatal outcome, Biochemical evidence of hepatic and renal dysfunction was an additional marker of a poor prognosis, but, in contrast to severe malaria in adults, none of these children with severe malaria had acute renal failure.