背景:疟疾是最致命的寄生虫病,每年全球仍有超过50万人死亡,主要是撒哈拉以南非洲五岁以下儿童的孩子。这项研究的目的是确定流行病学,阿米萨邦戈医院中心(CHRAB)严重疟疾患者的临床和实验室特征,Franceville的一家转诊医院.
方法:这是一项在CHRAB进行的为期10个月的观察性描述性研究。纳入了所有年龄段急诊病房的所有入院患者,这些患者均通过显微镜检查诊断为恶性疟疾阳性,并进行了世界卫生组织描述的具有严重疾病临床体征的快速测试。
结果:在这项研究中,1065名患者的疟疾检测呈阳性,其中220人患有严重的疟疾。四分之三(75.0%)的年龄小于5岁。平均咨询时间为3.5±1天。入院时最常见的严重症状是神经系统疾病92.27%(虚脱58.6%和惊厥24.1%)。其次是严重贫血72.7%,高乳酸血症54.6%,黄疸25%和呼吸窘迫21.82%。其他形式如低血糖,血红蛋白尿,发现肾功能衰竭的比例较低<10%.21名患者死亡,昏迷(aOR=15.54,CI5.43-44.41,p<0.01),低血糖(aOR=15.37,CI2.17-65.3,p<0.01),呼吸窘迫(aOR=3.85,CI1.53-9.73,p=0.004)和异常出血(aOR=16.42,CI3.57-104.73,p=0.003)被确定为致死性结局的独立预测因子.贫血与死亡率降低相关。
结论:严重疟疾仍然是一个主要影响5岁以下儿童的公共卫生问题。疟疾分类有助于确定最严重的患者,并有助于早期和适当地管理严重的疟疾病例。
BACKGROUND: Malaria is the most deadly parasitic disease and continues to claim more than a half million of deaths across the world each year, mainly those of under-fives children in sub-Saharan Africa. The aim of this study was to determine the epidemiological, clinical and laboratory features of patients with severe malaria at the Centre Hospitalier Régional Amissa Bongo (CHRAB), a referral hospital in Franceville.
METHODS: It was an observational descriptive study conducted at CHRAB over 10 months. All admitted patients at the emergency ward of all ages presenting with positive test to
falciparum malaria diagnosed by microscopy and rapid test with clinical signs of severe illness describe by World Health Organization were enrolled.
RESULTS: During this study, 1065 patients were tested positive for malaria, of them 220 had severe malaria. Three quarters (75.0%) were less than 5 years of age. The mean time to consultation was 3.5 ± 1 days. The most frequent signs of severity on admission were dominated by neurological disorders 92.27% (prostration 58.6% and convulsion 24.1%), followed by severe anemia 72.7%, hyperlactatemia 54.6%, jaundice 25% and respiratory distress 21.82%.The other forms such as hypoglycemia, haemoglobinuria, renal failure were found in low proportions < 10%. Twenty-one patients died, coma (aOR = 15.54, CI 5.43-44.41, p < 0.01), hypoglycemia (aOR = 15.37, CI 2.17-65.3, p < 0.01), respiratory distress (aOR = 3.85, CI 1.53-9.73, p = 0.004) and abnormal bleeding (aOR = 16.42, CI 3.57-104.73, p = 0.003) were identified as independent predictors of a fatal outcome. Anemia was associated with decreased mortality.
CONCLUSIONS: Severe malaria remains a public health problem affecting mostly children under 5 years. Classification of malaria helps identify the most severely ill patients and aids early and appropriate management of the severe malaria cases.