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作者报告了1例诊断困难的疟疾病例。患者为26岁的家庭妇女,在非洲扎伊尔逗留3个月后回到美国,3天后出现了连续3天的乏力、寒战、发热、恶心,症状消失2天后又复发,且伴有肩背痛及前额部头痛3天,于症状发作后9天住院。据患者诉述,在前3个月曾每周一次服用乙胺嘧啶。患者幼年即有心杂音、尿路反复感染及3年前曾患病毒性脑膜炎的病史。入院体检时,患者发热,心率稍快,整个主动脉区可听到2～6级的收缩期杂音;肝略肿大,左肋脊角轻度压痛;脾不大;怀孕已2个月,为正常宫内孕。实验室检查,血球容积44%;白细胞总数3,400/立方毫米,分类计数正常;血小板84,000/立方毫米;尿液查见少量蛋白和酮体外,余均正常;粪检未见寄生虫和虫卵。胸部X线检查未发现异常。心电图示ST段及T波的一般性改变。
The authors report a case of malaria that is difficult to diagnose. The patient, a 26-year-old housewife, returned to the United States after three months of stay in Zaire, Africa. She developed fatigue, chills, fever and nausea for 3 consecutive days after 3 days and relapsed two days after her symptoms disappeared, Pain and headache in the forehead for 3 days, hospitalized 9 days after the onset of symptoms. According to the patient’s complaint, pyrimethamine was taken once weekly during the first 3 months. Patients with childhood heart murmur, repeated urinary tract infection and three years ago had a history of viral meningitis. Admission examination, the patient fever, heart rate slightly faster, the whole aortic region can hear systolic murmur 2 to 6; slightly enlarged liver, mild left lobe tenderness; spleen is not; pregnancy has been 2 months, For normal intrauterine pregnancy. Laboratory tests, hematocrit 44%; white blood cells 3,400 / cubic millimeter, the normal classification count; platelets 84,000 / cubic mm; urine check a small amount of protein and ketone body, the remaining normal; no stool parasites and eggs. Chest X-ray examination found no abnormalities. ECG ST segment and T wave of the general change.