背景:在撒哈拉以南非洲(SSA),尽管最近有报道称疟疾发病率下降,但疟疾仍然是一个公共卫生问题。严重疟疾是一种多器官疾病,具有广泛的临床范围和结果,据报道因年龄而异,地理位置,传输强度随着时间的推移。有报道称最近疟疾流行或复发,但是数据很少,如果有的话,重点关注流行病期间严重疟疾的临床谱。这描述了乌干达东部疾病流行期间儿童严重疟疾的临床谱和结果。
方法:这项从2021年10月1日至2022年9月7日的前瞻性队列研究嵌套在疟疾流行病学,Mbale地区转诊医院在乌干达东部高度流行的病理生理和干预研究(TMA2016SF-1514-MEPIE研究),乌干达。60天至12岁的儿童在入院时检测出疟疾阳性,并符合WHO严重疟疾监测的临床标准。进行随访直到第28天。数据是使用定制的社会人口统计学特征形式收集的,临床表现,治疗,和结果。实验室分析包括全血细胞计数,疟疾RDT(SDBIOLINE疟疾AgP.f/Pan,Ref.05FK60-40-1)和血液载玻片,乳酸,葡萄糖,血液气体和电解质。此外,使用试纸进行尿液分析(Multistix®10SG,西门子,Ref.2300)在床边完成。使用STATAV15.0对数据进行分析。该研究事先得到了伦理批准。
结果:共招募了300名参与者。中位年龄为4.6岁,平均57.2个月,IQR44.5个月。许多孩子,164/300(54.7%)年龄在5岁以下,男性为171/300(57.0%)。常见的临床特征是虚脱236/300(78.7%),黄疸在205/300(68.3%),158/300年严重疟疾贫血(52.7%),黑水热158/300(52.7%)和多次惊厥51/300(17.0%),意识受损50/300(16.0%),酸中毒41/300(13.7%),呼吸窘迫26/300(6.7%)和昏迷18/300(6.0%)。在56/251(22.3%)中发现了长期住院,并与酸中毒有关,P=0.041。总死亡率为19/300(6.3%)。第28天的随访时间为247/300(82.3%)。
结论:在乌干达东部疟疾流行期间,严重的疟疾影响了年龄更大的儿童,频谱有更多的虚脱,黄疸严重的疟疾贫血,黑水热和多发性抽搐,早期报道的呼吸窘迫和脑型疟疾较少。
BACKGROUND: In sub-Saharan Africa (SSA), malaria remains a public health problem despite recent reports of declining incidence. Severe malaria is a multiorgan disease with wide-ranging clinical spectra and outcomes that have been reported to vary by age, geographical location, transmission intensity over time. There are reports of recent malaria epidemics or resurgences, but few data, if any, focus on the clinical spectrum of severe malaria during epidemics. This describes the clinical spectrum and outcomes of childhood severe malaria during the disease epidemic in Eastern Uganda.
METHODS: This prospective cohort
study from October 1, 2021, to September 7, 2022, was nested within the \'Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda\' (TMA2016SF-1514-MEPIE
Study) at Mbale Regional Referral Hospital, Uganda. Children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the clinical WHO criteria for surveillance of severe malaria were enrolled on the
study. Follow-up was performed until day 28. Data were collected using a customized proforma on social demographic characteristics, clinical presentation, treatment, and outcomes. Laboratory analyses included complete blood counts, malaria RDT (SD BIOLINE Malaria Ag P.f/Pan, Ref. 05FK60-40-1) and blood slide, lactate, glucose, blood gases and electrolytes. In addition, urinalysis using dipsticks (Multistix® 10 SG, SIEMENS, Ref.2300) at the bedside was done. Data were analysed using STATA V15.0. The
study had prior ethical approval.
RESULTS: A total of 300 participants were recruited. The median age was 4.6 years, mean of 57.2 months and IQR of 44.5 months. Many children, 164/300 (54.7%) were under 5 years, and 171/300 (57.0%) were males. The common clinical features were prostration 236/300 (78.7%), jaundice in 205/300 (68.3%), severe malarial anaemia in 158/300 (52.7%), black water fever 158/300 (52.7%) and multiple convulsions 51/300 (17.0%), impaired consciousness 50/300(16.0%), acidosis 41/300(13.7%), respiratory distress 26/300(6.7%) and coma in 18/300(6.0%). Prolonged hospitalization was found in 56/251 (22.3%) and was associated with acidosis, P = 0.041. The overall mortality was 19/300 (6.3%). Day 28 follow-up was achieved in 247/300 (82.3%).
CONCLUSIONS: During the malaria epidemic in Eastern Uganda, severe malaria affected much older children and the spectrum had more of prostration, jaundice severe malarial anaemia, black water fever and multiple convulsions with less of earlier reported respiratory distress and cerebral malaria.