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目的探讨北京地区境外输入性疟疾的流行病学和临床特征。方法对1997年1月至2012年8月,首都医科大学附属北京友谊医院热带病科收治的发病前一个月有境外旅居史的确诊疟疾患者192例,进行流行病学和临床特征分析。结果 192例患者中发病前一个月有非洲旅居史165例(86.5%)、东南亚旅居史25例(12.5%)、南美洲旅居史2例(1.0%)。发病到确定诊断平均时间8.4d±8.2d(2d～60d),确定诊断时疟疾快速诊断试验阳性168例(87.5%)。诊断为恶性疟96例(50.0%),间日疟38例(19.8%),间日疟和恶性疟混合感染26例(13.5%),未分型32例(16.7%)。出现意识障碍10例(5.2%),脾肿大188例(97.9%)、血小板减少129例(67.2%)、肝功能异常70例(36.5%)、贫血61例(31.8%)、肾功能异常19例(9.9%)。经青蒿素及其衍生物为基础的联合治疗后,第5d累计外周血涂片疟原虫检查转阴者166例(86.5%);至15d累计176例(91.7%)患者治愈出院,死亡1例(0.5%)。结论北京地区境外输入性疟疾以有非洲旅居史、男性中年患者为主,并且发病有逐年增加的趋势;疟疾诊断必须依靠反复外周血涂片及疟疾快速诊断试验检测,脾肿大和血小板减少可作为临床特征提示疟疾的存在,以青蒿素及其衍生物为基础的联合治疗效果可靠。
Objective To explore the epidemiology and clinical features of imported malaria outside of Beijing. Methods From January 1997 to August 2012, 192 cases of confirmed malaria cases with overseas travelers living in the month preceding the onset of fever were collected from Department of Tropical Diseases, Beijing Friendship Hospital, Capital Medical University. The epidemiological and clinical features were analyzed. Results There were 165 cases (86.5%) of living history in Africa, 25 cases living history in Southeast Asia (12.5%) and 2 cases living history in South America (1.0%) in 192 cases. The average diagnosis time from onset to diagnosis was 8.4d ± 8.2d (2d ~ 60d). A total of 168 cases (87.5%) of the malaria rapid diagnostic tests were positive at diagnosis. Ninety-six cases (50.0%) were diagnosed as falciparum malaria, 38 cases (19.8%) were Plasmodium vivax, 26 cases (13.5%) were mixed infection with Plasmodium falciparum and Plasmodium falciparum, and 32 cases (16.7%) were un-typed. There were 10 cases of disturbance of consciousness (5.2%), 188 cases of splenomegaly (97.9%), 129 cases of thrombocytopenia (67.2%), 70 cases of liver dysfunction (36.5%), 61 cases of anemia (31.8% 19 cases (9.9%). After artemisinin and its derivatives-based combination therapy, 166 cases (86.5%) of negative cumulative blood smear samples of Plasmodium were detected on the 5th day; 176 cases (91.7%) were cured and discharged to 15 days Example (0.5%). Conclusions The imported malaria in Beijing has a history of living in Africa with middle-aged male patients and the incidence tends to increase year by year. The diagnosis of malaria must rely on the rapid peripheral blood smear and malaria tests, splenomegaly and thrombocytopenia As a clinical indication for the presence of malaria, combination therapy based on artemisinin and its derivatives is reliable.