Severe and Complicated Falciparum Malaria-A Case Report and Brief Review

國際衛生組織於西元1965年宣布台灣為非瘧疾疫區。然而，近幾年來由於台灣經濟的發達，或者是因工商業的考察，抑或是旅遊等頻率的增加，輸入性瘧疾的病例正逐年增加之中。主要的國家來自於非洲及東南亞地區。而其中，惡性瘧疾造成的併發症尤其嚴重。如果沒有適時的診斷且積極有效的治療，甚至可能在病發後幾小時內就死亡。吾人報告了一例惡性瘧疾，他於病發前曾在泰國及緬甸停留，而於回台灣四天後發病。吾人在急診室即利用週邊血液抹片的檢查診斷為瘧疾，並且開始給予奎寧治療。住院期間，病患遭遇了各項嚴重的併發症，但經過仔細的照顧後，終於完全康復而出院，由於目前台灣年輕一代的醫師幾乎從未接觸過瘧疾，而輸入性瘧疾病例則持續增加，我們必須強調適時診斷的重要性，尤其是簡單而隨時可做的週邊血液抹片檢查。即使是惡性瘧疾，也是可以治癒的。另外對於進出疫區的人，給予適當且足夠時間的抗瘧藥預防，也是相當重要的一環。

關鍵字

惡性瘧疾；腦性瘧疾；低血糖；急性呼吸窘迫症；急性腎衰竭

並列摘要

Most patients with malaria present to their doctor with nonspecific symptoms such as fever, headache and slight scleral icterus. Making a high index of suspicion is necessary, especially to the travellers on returning from a malarious endemic area, even only a transient exposure history. Nearly 88% of falciparm malaria infection were acquired in West Africa in the early series, but a larger geographic area of acquisition of plasmodium falciparum including Thailand should be noticed. The eradication of malaria in Taiwan was announced by the WHO in 1965. But imported malaria rose steadily, especially in recent years due to increased frequency of travel and business. The non-use or the improper use of malarial prophylactic medication by the majority of individuals presenting with imported malaria. Our case presented as a full-brown severe and complicated falciparum malaria four days after retuning from Berma and Thailand encounted with the comlications including cerebral malaria, hypoglycemia, acute renal failure, adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), anemia, thrombocytopenia, hyponatremia, hepatosplenomegaly and liver function impairment. Malaria was diagnosed soon at ER by peripheral blood smear and received anti-malarial drug treatment with intravenous quinine for one week and then replaced by oral quinine plus tetracycline for another week. He was cured and discharged on the 51st hospital day.

並列關鍵字

Falciparum malaria ； Cerebral malaria ； Hypoglycemia ； ARDS ； Acute renal failure

國際替代計量

Severe and Complicated Falciparum Malaria-A Case Report and Brief Review

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