输入性COVID-19合并重症恶性疟病例临床分析

doi:10.12140/j.issn.1000-7423.2023.04.019

中国寄生虫学与寄生虫病杂志 ›› 2023, Vol. 41 ›› Issue (4): 506-509.doi: 10.12140/j.issn.1000-7423.2023.04.019

输入性COVID-19合并重症恶性疟病例临床分析

张乐¹^,²(), 夏加伟¹^,², 李翔¹^,³, 马仲序¹^,⁴, 姜建杰¹^,⁴, 唐娅琳¹^,², 刘澍¹^,², 张开义¹^,⁵^,^*()

1 云南省传染性疾病临床医学中心，昆明 650041
2 昆明市第三人民医院重症医学科，云南昆明 650041
3 昆明市第三人民医院影像科，云南昆明 650041
4 昆明市第三人民医院隔离病区，云南昆明 650041
5 昆明市第三人民医院结核科，云南昆明 650041

收稿日期:2022-10-24 修回日期:2023-01-29 出版日期:2023-08-30 发布日期:2023-09-06
通讯作者: *张开义（1980-），男，本科，副主任医师，从事感染性疾病诊疗工作。E-mail：zl2018346@eyou.com
作者简介:张乐（1982-），男，硕士，副主任医师，从事急危重症传染性疾病基础和临床研究。E-mail：9035643@qq.com
基金资助:
昆明市卫生科技人才培养项目-百工程(2021-SW(Province)-13)

Clinical analysis of imported COVID-19 cases complicated with severe falciparum malaria

ZHANG Le¹^,²(), XIA Jiawei¹^,², LI Xiang¹^,³, MA Zhongxu¹^,⁴, JIANG Jianjie¹^,⁴, TANG Yalin¹^,², LIU Shu¹^,², ZHANG Kaiyi¹^,⁵^,^*()

1 Clinical Medical Centre for Infectious Diseases in Yunnan Province, Kunming 650041, China
2 Department of Intensive Care Unit, The Third People's Hospital of Kunming, Yunnan 650041, Kunming, China
3 Department of Imaging, The Third People's Hospital of Kunming, Yunnan 650041, Kunming, China
4 Department of Isolation Ward, The Third People's Hospital of Kunming, Yunnan 650041, Kunming, China
5 Department of Tuberculosis, The Third People's Hospital of Kunming, Yunnan 650041, Kunming, China

Received:2022-10-24 Revised:2023-01-29 Online:2023-08-30 Published:2023-09-06
Contact: *E-mail: zl2018346@eyou.com
Supported by:
Kunming Health Science and Technology Talent Training Project-Hundred Project(2021-SW(Province)-13)

摘要/Abstract

摘要：

收集2022年8月在昆明市第三人民医院收治确诊的4例输入性新型冠状病毒感染（COVID-19）合并重症恶性疟的病历资料，对其流行病学、临床表现、实验室和影像学检查、治疗经过及预后进行回顾性分析。4例均为男性，年龄40~54岁，均有非洲工作和生活史。急性起病，以发热（4例）、畏寒（3例）、寒战（3例）、恶心呕吐（3例）、腹泻（4例）、乏力纳差（4例）为主要临床表现，头痛头晕、意识不清2例，小便失禁1例，肌肉酸痛2例，咳嗽2例，咳痰1例，咽痛1例。所有病例经咽拭子新型冠状病毒核酸检测均为阳性，外周血涂片镜检查见恶性疟原虫。所有病例符合重症疟疾诊断标准，均伴有肝功能异常及严重低蛋白血症，高胆红素血症2例，血脂异常3例，累及三系血象异常3例，降钙素原均有不同程度升高，乳酸酸中毒2例，低血糖1例；胸部CT提示病毒性肺炎改变1例。给予抗病毒药物及青蒿琥酯（静脉注射120 mg/次，0、12和24 h各1次，之后1次/d，连续7 d），并结合病情给予不同方案精准化治疗，均治愈出院。出院后随访，4例病例情况稳定。建议对境外疟疾高流行地区入境人员树立新型冠状病毒感染和疟疾同防意识，避免重症病例和死亡的发生。

关键词: 恶性疟, 新型冠状病毒感染, 临床分析

Abstract:

The medical records of 4 cases of imported coronavirus disease 2019 (COVID-19) complicated with severe falciparum malaria diagnosed in Kunming Third People's Hospital in August 2022 were collected. The epidemiology, clinical manifestations, laboratory and imaging examinations, course of treatment and prognosis of 4 cases were analysed retrospectively. All the 4 cases were male, aged 40-54 years, and had a history of work and life in Africa. All cases had acute onset of symptoms, including fever (4 cases), chills (3 cases), shivering (3 cases), nausea and vomiting (3 cases), diarrhea (4 cases), and poor appetite (4 cases) as the main clinical manifestations. Headache, dizziness, unclear consciousness were reported in 2 cases, urinary incontinence in 1 case, muscle soreness in 2 cases, cough in 2 cases, phlegm in 1 case, and pharyngalgia in 1 case. All cases were positive for coronavirus. Nucleic acid test by throat swabs, and Plasmodium falciparum was found by microscopy examination of peripheral blood smear. All cases met the diagnostic criteria for severe malaria and were accompanied by abnormal liver function and severe hypoproteinemia, 2 cases of hyperbilirubinemia, 3 cases of dyslipidemia, 3 cases of abnormal blood picture involving the third system, increased calcitonin to varying degrees, 2 cases of lactic acid acidosis, and 1 case of hypoglycemia. Chest CT showed changes of viral pneumonia in 1 case. Antiviral drug and artesunate (intravenous injection 120 mg/time, once at 0, 12 and 24 hours, and once a day later for 7 consecutive days) were given, and different schemes of precise treatment were given based on the condition of the patient. All the patients were cured and discharged, and the follow-up was stable. It is suggested that the awareness of COVID-19 and malaria co-prevention should be established among the entry personnel in the high malaria epidemic areas abroad, to avoid serious cases and deaths.

Key words: Falciparum malaria, Novel coronavirus pneumonia, Clinical analysis

中图分类号:

张乐, 夏加伟, 李翔, 马仲序, 姜建杰, 唐娅琳, 刘澍, 张开义. 输入性COVID-19合并重症恶性疟病例临床分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(4): 506-509.

ZHANG Le, XIA Jiawei, LI Xiang, MA Zhongxu, JIANG Jianjie, TANG Yalin, LIU Shu, ZHANG Kaiyi. Clinical analysis of imported COVID-19 cases complicated with severe falciparum malaria[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(4): 506-509.

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参考文献 16

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病例	白细胞/×10⁹·L^-1）	红细胞/×10¹²·L^-1	血红蛋白/g·L^-1	血小板/ ×10⁹·L^-1	谷丙转氨酶/ U·L^-1	谷草转氨酶/ U·L^-1	总胆红素/μmol·L^-1	直接胆红素/μmol·L^-1	间接胆红素/μmol·L^-1	白蛋白/ g·L^-1	甘油三酯/mmol·L^-1	血糖/mmol·L^-1	肌酐/μmol·L^-1	降钙素原/ng·mL^-1	超敏C反应蛋白/ mg·L^-1	酸碱度	碳酸氢根/mmol·L^-1	血乳酸/mmol·L^-1
1	3.33↓	2.87↓	57↓	14↓	221↑	358↑	250↑	92.7↑	157.3↑	22.3↓	4.87↑	4.93	128↑	3.86↑	162.80↑	7.33↓	10.3↓	11.23↑
2	6.26	4.38	114	22↓	102↑	208↑	149↑	52.8↑	96.2↑	25.4↓	6.62↑	1.2↓	119↑	4.42↑	114.30↑	7.22↓	15.8↓	11.07↑
3	2.39↓	2.63↓	48↓	28↓	115↑	283↑	33	18.8	14.2	21.5↓	1.68	7.38	61	1.72↑	195.48↑	7.42	22.1	3.82↑
4	3.29↓	3.79	75↓	26↓	100↑	37	35.8↑	18.8↑	17	25.9↓	5.68↑	21.99↑	136↑	4.5↑	158.68↑	7.33↓	15.3↓	3.36↑

病例	恶性疟原虫涂片镜检	疟原虫密度 /个·μl^-1	疟原虫转阴时间 /d	2019-nCoV核酸Ct值（O/N基因）	核酸转阴时间 /d
1	早期滋养体	413 793	5	20.6/19.6	10
2	早期滋养体/晚期滋养体	580 106	4	23.3/22.6	14
3	早期滋养体/配子体	2 920	4	36.7/34.8	1
4	早期滋养体/配子体	2 280	3	33.5/34.3	1

输入性COVID-19合并重症恶性疟病例临床分析

Clinical analysis of imported COVID-19 cases complicated with severe falciparum malaria

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病例	发热	畏寒	寒战	头痛	头晕	咳嗽	咳痰	咽痛	肌肉酸痛	恶心	呕吐	腹泻	乏力	纳差	意识障碍	小便失禁
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病例	发热	畏寒	寒战	头痛	头晕	咳嗽	咳痰	咽痛	肌肉酸痛	恶心	呕吐	腹泻	乏力	纳差	意识障碍	小便失禁
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病例	发热	畏寒	寒战	头痛	头晕	咳嗽	咳痰	咽痛	肌肉酸痛	恶心	呕吐	腹泻	乏力	纳差	意识障碍	小便失禁
1	+	+	+	+	+	+	-	+	+	+	+	+	+	+	+	-
2	+	-	-	-	-	+	+	-	-	-	-	+	+	+	-	-
3	+	+	+	+	+	-	-	-	+	+	+	+	+	+	+	+
4	+	+	+	-	-	-	-	-	-	+	+	+	+	+	-	-