目的 了解2020—2024年湖北省恶性疟疫情流行特征，以及病例临床症状和实验室检测情况，为防止重症病例和死亡病例的发生提供参考。方法 采集传染病信息报告管理系统和寄生虫病防治信息管理系统中湖北省2020—2024年报告的恶性疟病例信息，对病例的三间分布、就诊情况和实验室检测情况等进行统计分析。结果 2020—2024年湖北省共报告恶性疟251例，99.60%（250/251）为境外输入病例，1例为输血感染。其中，重症病例占12.35%（31/251）；死亡病例2例，占0.80%（2/251）。恶性疟病例数占疟疾病例总数的68.02%（251/369），各年度恶性疟病例数占比差异有统计学意义（χ² = 35.431，P < 0.01）。恶性疟病例输入源以非洲国家为主（占98.80%，247/250），输入性病例数量前3位国家分别为刚果民主共和国（65例）、尼日利亚（46例）和几内亚（19例）。1月份报告恶性疟病例数最多，病例以31~50岁青壮年男性为主。报告病例数前3位市分别为武汉市（86例）、黄石市（41例）和宜昌市（33例），全省70.87%（73/103）的县（区）有恶性疟病例报告。恶性疟病例初诊确诊率为74.90%（188/251），村卫生室和个体医生初诊确诊率较低，仅1/13和1/8。省级、市级、县级和乡镇及以下医疗单位间的初诊确诊率分别为73.08%（19/26）、89.22%（91/102）、81.93%（68/83）、25.00%（10/40），差异有统计学意义（χ² = 66.325，P < 0.01）。恶性疟病例发病至就诊时间间隔中位数为1 d，1 d内就诊病例占54.18%（136/251），3 d内就诊病例占81.67%（205/251）；就诊至确诊时间间隔中位数为1 d，1 d内确诊病例占65.74%（165/251），3 d内确诊病例占88.45%（222/251）。98.41%（247/251）的病例有不同程度的发热，发冷、出汗、头痛、肌肉疼痛分别占57.37%（144/251）、42.23%（106/251）、47.41%（119/251）和10.36%（26/251）。16.33%（41/251）的恶性疟病例出现严重贫血、肝肾损伤等并发症。240份病例抗凝血样快速诊断检测、镜检和实时荧光定量PCR的恶性疟检出率分别是98.33%（236/240）、95.42%（229/240）和100%（240/240），差异有统计学意义（χ² = 12.664，P < 0.05）。240份外周血涂片可查见疟原虫，70.42%（169/240）的血涂片只见单一环状体期，20.83%（50/240）的血涂片可见环状体期和滋养体期，5.00%（12/240）的血涂片可见环状体、滋养体、裂殖体和配子体等各期虫体。疟原虫密度为1~10万个/μL的血涂片占比最高，为34.17%（82/240）；密度为25万个/μL以上的血涂片占21.25%（51/240）。多因素logistic回归分析显示，疟原虫密度是引起重症疟疾的独立危险因素（OR > 1，P < 0.05）。结论 2020—2024年湖北省恶性疟病例数较多且分布广泛，输入来源地主要为非洲，发热为主要临床症状，部分病例确诊时间较长，输入性恶性疟重症率较高，今后应提升患者就诊意识，缩短确诊时间，及时规范治疗，减少重症和死亡病例的发生。

Objective To investigate the epidemiological characteristics, clinical manifestations and laboratory tests of Plasmodium falciparum malaria in Hubei Province from 2020 to 2024, so as to provide insights into prevention of development of severe and fatal cases. Methods Data pertaining to P. falciparum malaria cases reported in Hubei Province from 2020 to 2024 were collected from the National Notifiable Disease Reporting System and the National Parasitic Disease Control Information Management System. The temporal, spatial and population distributions, healthcare-seeking behaviors and laboratory testing of P. falciparum malaria cases were statistically analyzed. Results A total of 251 P. falciparum malaria cases were reported in Hubei Province from 2020 to 2024, including 250 imported cases (99.60%, 250/251) and one case caused by blood transfusion, and 31 severe cases (12.35%, 31/251) and 2 deaths (0.80%). P. falciparum malaria consisted 68.02% (251/369) of all malaria cases, and the proportion of P. falciparum malaria cases in all malaria cases varied in years (χ² = 35.431, P < 0.01). The majority of imported P. falciparum malaria cases acquired infections from Africa (98.80%, 247/250), with the Democratic Republic of Congo (65 cases), Nigeria (46 cases), and Guinea (19 cases) as three largest sources of importation. The largest number of reported P. falciparum malaria cases was found in January, with males aged 31 to 50 years as the predominant demographic. Wuhan City (86 cases), Huangshi City (41 cases), and Yichang City (33 cases) as the three most highly affected cities, and P. falciparum malaria cases were reported in 70.87% (73/103) of counties (districts). The proportion of definitive diagnosis of P. falciparum malaria cases was74.90% (188/251) at initial diagnosis, and lower proportions were observed at village clinics (1/13) and among private practitioners (1/8). The proportions of definitive diagnosis of P. falciparum malaria cases were 73.08% (19/26), 89.22% (91/102), 81.93% (68/83), and 25.00% (10/40) at provincial-, city-, county-, and township and lower-level medical institutions, respectively (χ² = 66.325, P < 0.01). The median interval from disease onset to healthcare seeking was 1 day among P. falciparum malaria cases, with 54.18% (136/251) seeking healthcare services within 1 day of onset and 81.67% (205/251) within 3 days, and the median interval from healthcare seeking to definitive diagnosis was 1 day, with 65.74% (165/251) confirmed within 1 day of seeking healthcare services and 88.45% (222/251) within 3 days. Fever was the most frequent symptom (98.41%, 247/251), and other common symptoms included chills (57.37%, 144/251), sweating (42.23%, 106/251), headache (47.41%, 119/251), and myalgia (10.36%, 26/251). Complications occurred in 16.33% (41/251) of subjects, including severe anemia and liver and kidney injury. The detection rates of P. falciparum malaria were 98.33% (236/240), 95.42% (229/240), and 100% (240/240) in 240 anticoagulant blood samples from P. falciparum cases by rapid diagnostic tests (RDTs), microscopy, and quantitative Real-time PCR assay, respectively (χ² = 12.664, P < 0.05). P. falciparum was identified in peripheral blood smears from 240 P. falciparum malaria cases, with ring-stage alone seen in 70.42% (169/240) of blood smears, rings and trophozoites seen in 20.83% (50/240), and parasites at all developmental stages (rings, trophozoites, schizonts and gametocytes) in 5.00% (12/240). There were 34.17% (82/240) of cases with parasitemias ranging from 1/μL to 100 000/μL, and 21.25% (51/240) with parasitemias of > 250 000/μL. Multivariate logistic regression analysis identified parasitemia was an independent risk factor for severe malaria (OR > 1, P < 0.05). Conclusion A large number of P. falciparum malaria cases with widespread distributions were reported in Hubei Province from 2020 to 2024, and most cases acquired infections in Africa. Fever was the major clinical symptom. Some cases experienced a prolonged duration for a definitive diagnosis, and the proportion of severe case was high among imported P. falciparum malaria cases. Future efforts should focus on improving patients’ awareness of seeking healthcare services, shortening the duration to definitive diagnosis, providing timely and standardized treatment, in order to reduce the development of severe and fatal cases.