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重型恶性疟的治疗

Author
Terrie E Taylor, DO
Section Editor
Johanna Daily, MD, MSc
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
翁亚丽, 主任医师

引言

疟疾流行于热带大部分地区。108个国家的大约30亿人暴露于疟疾中，每年大约2.43亿人会发生有症状的疟疾[1]。其中大部分归因于恶性疟原虫(Plasmodium falciparum )(90%)，但间日疟原虫(Plasmodium vivax )和诺氏疟原虫(Plasmodium knowlesi )也可引起严重的疾病[2,3]。每年大约有863,000例疟疾致死病例；80%以上的死亡发生于撒哈拉以南的非洲儿童中。

重型疟是具有器官功能障碍重要征象和/或高水平疟原虫血症的急性疟疾[4]。在流行区，年幼儿童和妊娠女性发生重型疟的风险很高。较年长儿童及成人在反复感染后可形成部分免疫，因此这类人群发生重型疟的风险较低。到达疟疾流行地区的旅行者一般在之前未暴露于疟原虫，所以其发生重型疟的风险较高。

鉴于涉及多个器官系统的感染有较复杂的病理生理学，重型疟患者的治疗存在很多临床挑战。在获取诊断和治疗手段的途径可能受限的流行地区，这些挑战成倍地增加。尽管如此，为这些患者提供非常好的治疗是有可能的。

本文将总结重型恶性疟的治疗方法，也将讨论流行区和非流行区重型恶性疟治疗的相关问题。非重型疟的治疗将单独讨论。 (参见“Treatment of uncomplicated falciparum malaria in nonpregnant adults and children”和“妊娠女性疟疾的预防和治疗”)

定义

重型恶性疟一般定义为具有严重表现和/或重要器官功能障碍证据的急性疟疾[5-7]：

                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-26.
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