Clinical epidemiological analysis of imported malaria in Shanghai

Abstract

Abstract:

Objective To evaluate the epidemiological characteristics of imported malaria and analyze the risk factors for severe malaria in Shanghai, China. Methods A retrospective review was made on imported malaria cases treated in Shanghai Public Health Clinical Center during 2013-2015, focusing on the demographic information, epidemiological data, and laboratory data. Comparisons between groups were made with Mann-Whitney test and Fisher’s exact test, and risk factors were analyzed with multivariate logistic regression. Results Eighty-seven imported malaria cases (82 males and 5 females) were reviewed, with an average onset age of 36.4, comprising 79 Chinese (90.8%), 3 South Sudanese (3.4%), 2 Indians (2.3%), and one from each of Cameroon, Nigeria, and Burundi (1.1%). Seventy-five cases had a defined region of malaria source, with a dominance in African countries (63, 84.0%) and then in Asia (11, 14.7%). Seventy-eight (89.7%) were confirmed by laboratory tests while 9(10.3%) were clinically diagnosed. Among the laboratory confirmed cases, 89.7% were infected with Plasmodium falciparum and 10.3% with P. vivax. Twenty cases(23.0%) had a history of malaria infection. The median of duration from symptom onset to admission was 5 days and 30 (34.5%) patients received anti-malaria drug treatment within 48 hours after onset. Eighteen patients met the diagnostic criteria of severe malaria, of whom 1 showed cerebral malaria, 17 had serum total bilirubin elevating to > 43 μmol/L and 3 had a high serum creatinine level above 265 μmol/L. Multivariate logistic regression showed that medication within 48 h after onset was an independent risk factor for severe malaria (OR = 0.05, 95%CI 0.01-0.43, P < 0.05). Conclusion Plasmodium falciparum remains a major pathogen for imported malaria in Shanghai. Africa is the major region of malaria source. Timely medication after disease onset reduces the risk for sever malaria.

Key words: Imported malaria, Clinical epidemiology, Risk factor, Severe malaria, Plasmodium falciparum

CLC Number:

R531.3

Xu-hua JIANG, Yu-xian HUANG, Yun LING, Ai-hong ZHU, Shan-ke YE, Qin HUANG. Clinical epidemiological analysis of imported malaria in Shanghai[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2017, 35(2): 150-155.

Figures/Tables 4

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变量 Variate	因素 Factors	赋值 Value Assignment
Y	是否重症Severe case	否 = 0,是 = 1 No = 0, yes = 1
X1	年龄 < 40岁 Age < 40	否 = 0,是 = 1 No = 0, yes = 1
X2	种族 Ethnicity	其他人种 = 0,黄种人 = 1 Others = 0, asian = 1
X3	发病后48 h内服用抗疟疾药物Anti-malaria drugs taken with in 48 hours after disease onset	否 = 0,是 = 1 No = 0, yes = 1
X4	感染恶性疟原虫Plasmodium falciparum infection	否 = 0,是 = 1 No = 0, yes = 1
X5	既往有疟疾病史History of plasmodium infection	否 = 0,是 = 1 No = 0, yes = 1
X6	发病至收治时间Duration from onset to admission	输入性疟疾患者: < 5 d = 0,≥ 5 d = 1 For all imported malaria patients: < 5 days = 0, ≥ 5 days = 1 输入性恶性疟患者: < 4 d = 0,≥4 d= 1 For imported falciparum malaria patients: < 4 days = 0, ≥ 4 days = 1

项目 Item	感染不同疟原虫类型的病例数（%） No. case infected with different Plasmodium species（%）				总计 Total
项目 Item	三日疟原虫 P. malariae	卵形疟原虫 P. ovale	恶性疟原虫 P. falciparum	间日疟原虫 P. vivax	总计 Total
病例分类Classification of malaria cases
临床诊断Clinically diagnosed cases	0	0	9（100）	0	9
实验室确诊Confirmed cases using laboratory tests（%）	1（1.3）	1（1.3）	66（84.6）	10（12.8）	78
镜检 Smear positive（%）	1（1.6）	1（1.6）	52（83.9）	8（12.9）	62
抗原检测 Antigen detection positive（%）	1（1.3）	1（1.3）	66（84.6）	10（12.8）	78
年份 Year
2013	1（3.9）	1（3.8）	23（88.5）	1（3.8）	26
2014	0	0	28（87.5）	4（12.5）	32
2015	0	0	24（82.8）	5（17.2）	29
合计 Total	1	1	75	10	87

感染来源地国家 Country as infection source（n = 75）	感染不同疟原虫类型的病例数 No. case infected with different Plasmodium species				总计Total
感染来源地国家 Country as infection source（n = 75）	三日疟P. malariae	卵形疟P. ovale	恶性疟P. falciparum	间日疟P. vivax	总计Total
亚洲 Asia	0	0	2	9	11
印度 India	0	0	0	3	3
印度尼西亚 Indonesia	0	0	2	6	8
北美洲 North America	0	0	1	0	1
海地 Haiti	0	0	1	0	1
非洲 Africa	1	1	60	1	63
几内亚 Guinea	0	0	6	0	6
刚果布 The Republic of Congo	0	0	1	0	1
刚果金 Democratic Republic of the Congo	0	0	1	0	1
加纳 Ghana	0	0	9	0	9
加蓬 Gabon	0	0	1	0	1
南苏丹 South Sudan	1	0	2	0	3
南非 South Africa	0	0	3	0	3
喀麦隆 Cameroon	0	0	4	0	4
坦桑尼亚 Tanzania	0	0	1	0	1
塞拉利昂 Sierra Leone	0	0	1	0	1
多哥 Togo	0	0	1	0	1
安哥拉 Angola	0	0	7	0	7
尼日利亚 Nigeria	0	0	12	0	12
布隆迪 Burundi	0	0	1	0	1
科特迪瓦 Cote d′Ivoire	0	0	2	0	2
肯尼亚 Kenya	0	0	1	0	1
苏丹 Sudan	0	0	0	1	1
莫桑比克 Mozambique	0	0	1	0	1
赞比亚 Zambia	0	0	3	0	3
赤道几内亚 Equatorial Guinea	0	1	3	0	4
合计Total	1	1	63	10	75

项目 Item	输入性非恶性疟患者（n =12 ） Imported non-falciparum malaria patients (n = 12)	输入性恶性疟患者（n = 75） Imported falciparum malaria patients (n = 75)
既往有疟疾史人数（%） No. cases with a history of Plasmodium infection （%）	8	12（16.0）
发病至收治时间/d Duration from onset to admission/days	6.5	4.0
发病后48 h内服用抗疟疾药物人数（%） No. cases taking anti-malaria drugs 48 hours after disease onset（%）	5	25（33.3）
发病期间最高体温/℃ Maximum body temperature during onset/℃	39.62 ± 0.84	39.36 ± 0.73
血红蛋白/g·L^-1 Hemoglobin/g·L^-1	118.00	134.00
血小板计数/ × 10⁹·L^-1 Platelet/ × 10⁹·L^-1	75.00	78.00
血清丙氨酸转氨酶/U·L^-1 Serum alanine aminotransferase/U·L^-1	21.00	37.00
血清总胆红素/μmol·L^-1 Serum total bilirubin/μmol·L^-1	17.25	22.00
血清肌酐/μmol·L^-1 Serum creatinine/μmol·L^-1	75.60	77.90
未服药者疟原虫涂片检查阳性人数（%） No. un-medicated patients with positive smear test (%)	7	44 (88.0)
未服药者疟原虫抗原检查阳性人数（%） No. un-medicated patients with positive antigen (%)	7	48 (96.0)
重症病例数（%） No. severe cases (%)	1	17 (22.7)