https://scholars.lib.ntu.edu.tw/handle/123456789/556861
標題: | Imported malaria: Successful treatment of 31 patients in the era of chloroquine resistance | 作者: | CHI-TAI FANG SHAN-CHWEN CHANG Chang H.-L. YEE-CHUN CHEN PO-REN HSUEH CHIEN-CHING HUNG Hsieh W.-C. |
公開日期: | 1999 | 卷: | 98 | 期: | 10 | 起(迄)頁: | 683-687 | 來源出版物: | Journal of the Formosan Medical Association | 摘要: | The diagnosis and management of imported malaria presents a continuing challenge in developed countries, including Taiwan. We retrospectively analyzed the records of all 31 patients with imported malaria treated at National Taiwan University Hospital from January 1984 through December 1998. Plasmodium falciparum was identified as the causative malarial parasite in 18 patients, P. vivax in 12, and P. ovale in one. All 31 patients had fever, but only 13 presented with the characteristic fever pattern. The most common initial laboratory abnormalities were thrombocytopenia (20/31), mild hyperbilirubinemia (20/31), and leukopenia (7/31). The median time from the onset of fever to the correct diagnosis was 4 days for P. falciparum and 5 days for P. vivax. In 28 cases, the clue that led to early diagnosis was the patient's travel history. Quinine, but not chloroquine, was effective in 17 out of 18 cases of falciparum malaria. Three patients treated with intravenous quinine required a change of regimen because of life-threatening quinine toxicity; artesunate served as a safe and effective alternative in this situation. While most patients with tertian malaria were cured with the standard chloroquine and primaquine regimen, a higher dosage was required for one case acquired in Papua New Guinea. All patients, including two with severe malaria, survived. We conclude that, the mortality of imported malaria in the chloroquine resistance era can be minimized with early recognition by obtaining a thorough travel history, and instituting appropriate antimalarial chemotherapy based on precise identification of species. Quinine toxicity should be closely monitored, especially when this drug is given intravenously. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-0032745404&partnerID=40&md5=58628c9230e01b647b75f50dfc128fe0 https://scholars.lib.ntu.edu.tw/handle/123456789/556861 |
ISSN: | 0929-6646 | SDG/關鍵字: | artesunate; chloroquine; fansidar; mefloquine; primaquine; quinine; article; clinical article; diarrhea; drug resistance; fever; human; hyperbilirubinemia; hypotension; intravenous drug administration; leukopenia; lung edema; malaria; nausea; plasmodium falciparum; plasmodium ovale; plasmodium vivax; seizure; shock; thrombocytopenia; tinnitus; visual impairment; Adolescent; Adult; Antimalarials; Artemisinins; Child; Chloroquine; Drug Resistance; Female; Humans; Malaria; Male; Middle Aged; Primaquine; Quinine; Retrospective Studies; Sesquiterpenes; Travel |
顯示於: | 流行病學與預防醫學研究所 |
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