Comparative features and outcomes of malaria at a tertiary care hospital in Karachi, Pakistan
Comparative features and outcomes of malaria at a tertiary care hospital in Karachi, Pakistan
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DOI：
10.1016/j.ijid.2007.04.006
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发表时间：
2008-01-01
影响因子：
8.4
通讯作者：
Smego, R., Jr.
中科院分区：
文献类型：
--
作者：
Beg, M. A.;Sani, N.;Smego, R., Jr.
目的：比较间日疟原虫感染患者的临床和实验室特征、诊断方法、药物治疗和转归。方法：对4年半期间收治的521例疟疾患者的临床资料进行分析。结果：间日疟原虫感染占51.8%，恶性疟原虫占46.5%，间日疟原虫加恶性疟原虫占1.3%，疟疾占0.4%。与间日疟相比，恶性疟患者的呕吐(优势比OR=1.86，P=0.001)和腹痛(OR=1.6，P=0.024)的发生率更高，肝大、脾大和黄疸的发生率也较高。低的血红蛋白水平是常见的，但显著高于恶性疟原虫，肌酐水平显著高于恶性疟原虫。治疗方案包括单一药物治疗(61.5%)、适当联合治疗(15.8%)和不适当联合治疗(22.7%)。单用抗疟药包括氯喹(38.7%)、奎宁(19%)和多西环素(1.5%)。总死亡率为1.7%(n=9)，近56%的患者出现疾病并发症，最常见的是血小板减少症(36.4%)、贫血(23.4%)和血小板减少合并贫血(32.7%)。我们发现单独使用抗疟疾药物的比例很高，以及不适当的联合治疗(22.7%)，以及伯氨喹晚期预防措施的使用不足。医生需要熟悉疟疾流行区的治疗指南。(C)2007年国际传染病学会。爱思唯尔有限公司出版。保留所有权利。
Objectives: A comparison of clinical and laboratory features, diagnostic methods, drug treatment, and outcomes for patients hospitalized with malaria by Plasmodium species.Methods: Records of 521 patients hospitalized during the four and half-year study period were analyzed.Results: Infections were caused by Plasmodium vivax (51.8%), Plosmodium falciporum (46.5%), P vivax plus P falciparum (1.3%), and Plasmodium malariae (0.4%). Vomiting (odds ratio (OR) = 1.86, p = 0.001) and abdominal pain (OR = 1.60, p = 0.024) occurred more frequently inpatients infected with P falciparum compared to P vivax; this was also the case for hepatomegaly, splenomegaly and jaundice. Low hemoglobin levels were common but were significantly tower with P falciparum, and creatinine levels were significantly higher with P falciparum. Treatment regimens consisted of single drug therapy (61.5%), appropriate combination therapy (15.8%), and inappropriate combination therapy (22.7%). Antimalarials given alone included chloroquine (38.7%), quinine (19%) and doxycycline (1.5%). The overall mortality was 1.7% (n = 9) and nearly 56% of patients developed disease complications, most commonly thrombocytopenia (36.4%), anemia (23.4%), and thrombocytopenia plus anemia (32.7%).Conclusions: Despite resistance, chloroquine was prescribed in patients with malaria requiring hospitalization. We found a high proportion of single antimalarial drug use as well as inappropriate combination therapy (22.7%), and inadequate use of primaquine terminal prophylaxis. Physicians need to be acquainted with malaria treatment guidelines in an endemic zone. (C) 2007 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.