【摘要】 目的通过对淮安市二例疟疾病例死亡案例分析,为制定消除疟疾后监测提供科学依据。方法收集整理消除疟疾行动计划以来淮安市疟疾死亡病例的诊治过程、个案流行病学调查进行分析汇总。结果 2010年启动消除疟疾行动计划以来,淮安市共报吿2例疟疾死亡病例,均为男性青壮年,有明确非洲高疟区生活史。病例1,在安哥拉生活2年,回国后12 d出现发热症状,发病后第3天到私人小诊所接受输液治疗,发病后第4天到市级医院就诊,未查到疟原虫,至发病后第5天才明确诊断;病例2,在坦桑尼亚生活2年,回国后第14天出现呕吐、腹泻症状,第15天出现畏寒、发热症状,至所在地县级医院就诊,镜检未查见疟原虫,给予消炎抗菌治疗,发病后第4天到市级医院就诊,发病后第7天才明确诊断。2例疟疾病例均因病情凶险,持续恶化,出现了不可逆转的肺部感染、严重脑损伤和多器官衰竭,经抢救无效而死亡。结论就诊不及时和诊治延误是导致疟疾病例死亡的主要原因。消除阶段后监测更需有针对性的对高疟区回国人员开展健康宣教,提高患者的早就诊意识和临床医生的疟疾诊治能力,提升镜检人员的专业技能,减少重症病例,防止疟疾死亡病例的发生。更多还原

【Abstract】 Objective To analysis two cases of malaria death in Huai’an City, and to provide a scientific basis for thedevelopment of post-malaria elimination monitoring. Methods The data including the diagnosis and treatment of malariadeaths, and epidemiological case investigation in Huai’an City after the initiation of malaria elimination program has beencollected and analyzed. Results Since the initiation of malaria elimination program in 2010, Huai’an City has reported twomalaria death cases. All the death patients were young men and had definite histories of living in the malaria epidemic areas ofAfrica. One of the two patients had lived in Angola for two years. On 12 th day after returning home, he developed feversymptom. 3 days later, he went to a private clinic for infusion treatment. On the 4 th day after onset, he went to a municipalhospital, but malaria parasite was not detected. Until the 5 th day, his disease was diagnosed. The other patient had lived inTanzania for two years. On 14 th day after returning home, he suffered vomiting and diarrhea. On the 15 th day, he showed signsof chills and fever. Then, he went to a county hospital for an antibacterial treatment, but malaria parasite was not detected. Onthe 4 th day after onset, he went to a municipal hospital, and until the 7 th day, his disease was diagnosed. The two cases wereboth dangerous, and then continued to deteriorate, which had caused irreversible lung infection, severe brain injury andmultiple organ dysfunction syndrome(MODS). In the end, they died despite emergency rescue efforts. Conclusions Visitingdoctor not in time and delay in diagnosis are the main causes of death in malaria cases. In the monitoring after malariaelimination, we should continue to strengthen the health education of returnees in area of high malaria endemicity, in order toarise their awareness of early diagnosis, and improve clinical doctor’s ability of malaria diagnosis and treatment, enhance theprofessional skills of the blood slide examiners, so as to reduce severe case and prevent death from malaria.更多还原