背景:疟疾是一种由按蚊传播的潜在致命的寄生虫病。美国已经报道了局部获得性感染的复发
目的:这篇叙述性综述为急诊临床医生提供了疟疾的重点概述,包括流行病学,介绍,诊断,和疾病的管理。
结论:疟疾是由疟原虫引起的,由按蚊传播。疾病的严重程度可以从轻度到严重。任何来自流行地区的返回旅行者都应考虑疟疾,以及那些无法解释的周期性因素,症状发作或原因不明的发烧。患者最常出现发烧和僵硬,但也可能出现咳嗽,肌痛,腹痛,疲劳,呕吐,和腹泻。肝肿大,脾肿大,苍白,黄疸是与疟疾有关的发现。虽然不太常见,严重的疟疾是由微血管阻塞和贫血并发症引起的,酸中毒,低血糖,多器官衰竭,和脑型疟疾。外周血涂片仍是诊断的金标准,但是快速诊断测试是可用的。治疗包括专家咨询和根据氯喹耐药性定制的抗疟疾药物,旅行的地理区域,和病人合并症。可能需要支持性护理,严重疟疾患者将需要复苏。大多数患者将需要入院治疗和进一步监测。
结论:急诊医学临床医生应了解介绍,诊断,评估,和疟疾管理,以确保最佳结果。
Malaria is a potentially fatal parasitic disease transmitted by the Anopheles mosquito. A resurgence in locally acquired infections has been reported in the U.S.
This narrative
review provides a focused overview of malaria for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease.
Malaria is caused by Plasmodium and is transmitted by the Anopheles mosquito. Disease severity can range from mild to severe. Malaria should be considered in any returning traveler from an endemic region, as well as those with unexplained cyclical, paroxysms of symptoms or unexplained fever. Patients most commonly present with fever and rigors but may also experience cough, myalgias, abdominal pain, fatigue, vomiting, and diarrhea. Hepatomegaly, splenomegaly, pallor, and jaundice are findings associated with malaria. Although less common, severe malaria is precipitated by microvascular obstruction with complications of anemia, acidosis, hypoglycemia, multiorgan failure, and cerebral malaria. Peripheral blood smears remain the gold standard for diagnosis, but rapid diagnostic tests are available. Treatment includes specialist consultation and antimalarial drugs tailored depending on
chloroquine resistance, geographic region of travel, and patient comorbidities. Supportive care may be required, and patients with severe malaria will require resuscitation. Most patients will require admission for treatment and further monitoring.
Emergency medicine clinicians should be aware of the presentation, diagnosis, evaluation, and management of malaria to ensure optimal outcomes.