目的 探讨中国驻利比里亚绥德鲁维和任务区疟疾和普通呼吸道、肠道感染及其他疾病的临床特点和鉴别诊断.方法 对北京军区第13 批赴利维和医疗分队二级医:门诊及住:39 例疟疾(A组)、29 例非疟疾(B 组)患者的临床资料进行回顾性分析.结果 A 组患者中以出现发热并伴或不伴有其他症状就诊者25 例,快速疟-虫检测(RDT)阳性19 例;未诉发热而仅以头痛、肌肉酸痛、倦怠或食欲差、腹泻等前驱症状就诊者14 例,RDT 阳性2 例;所有18 例RDT 阴性患者在随后3 天内复诊RDT 均转阳;A 组恶性疟36 例,混合型疟疾3 例,镜下厚/薄血涂片检测17 例找到疟-虫.A 组住:患者5 人,均为初诊高热、RDT 阳性者.初诊RDT 阴性者分别诊断为急性上呼吸道感染、急性肠炎、风湿性关节炎等给予抗感染及对症处理,初诊误诊率46.2%(18/39),待RDT 阳转后给予抗疟治疗,39 例均临床治愈.B组29 例非疟疾患者初诊RDT 均为阴性,分别诊断为急性上感、扁桃体炎、肠炎、风湿性关节炎等,5 天内复诊RDT 均为阴性,该组患者给予抗感染、对症处理等后痊愈,其中3 例2 周后再度发热查RDT 阳性,给予口服抗疟治疗后治愈.结论 在西非高疟区表现发热和/或呼吸道/肠道不适、肌肉酸痛等症状者应高度怀疑疟疾,但RDT 检测阴性时不宜给予抗疟治疗,须每日复查RDT,RDT 和/或血涂片阳性者方给予抗疟治疗.距初诊4d 内RDT 阳转者则应考虑初诊时已感染疟疾,但延误抗疟治疗3~4d 不会影响预后;距初诊5d 后RDT 方转阳性者可基本排除初诊时已感染疟疾,后来RDT 阳性应考虑初诊后才被感染疟疾.由于疟疾早期诊断困难,漏误诊不可避免,但RDT 阳转后及时抗疟治疗基本不影响预后,对所有怀疑疟疾而RDT 阴性者均采取抗疟治疗似乎不妥.%Objective To explore the clinical feature and antidiastole of malaria and ordinary respiratory tract and intestinal infection and the other diseases in Chinese peace-keeping task region in Zwedru, Liberia. Methods Analyzing retrospectively the data of 39 malaria (group A) and 29 no-malaria (group B) outpatients and inpatients in the Chinese Level- Ⅱ hospital in the Liberia, which is organized by thirteenth peace-keeping medical contingent from Beijing military district. Results A total of 25 patients from group A had a fever accompany the other symptoms or not, and among them 19 ones showed positive result of rapid diagnosis test (RDT) to plasmodium. 14 patients from group A had precursory symptom such as headache, muscular soreness, lassitude or diarrhea, et al, but had no fever, among them positive RDT had two ones. All 18 negative RDT ones from group A turned to positive results after 3 days, group A included 36 falciparum malaria and 3 mixed malaria patients, and 17 ones were founded plasmodium in the thick/thin blood smear, and 5 inpatients were all ardent fever, positive RDT. Negative RDT patients at first visit were diagnosed acute upper respiratory infection, chordapsus, et al, who were given anti-infection and aim at signs' treatments. Misdiagnosis proportion was 46.2%( 18/39) at first visit. 39 malaria ones were all clinical recovery after anti-malaria treatments. A total of 29 patients from group B were negative RDT at first visit, which were diagnosed acute upper respiratory infection, amygdalitis, enteritis, et al, respectively. Their RDT to plasmodium were all negative repeatedly during next 5 days, but 3 ones among them turned to positive RDT when they felt fever again after 2 weeks. The 3 patients recovered after anti-malaria treatment. Conclusion All patients should be doubted malaria extremely when they appear fever or their respiratory tract or intestinal tract unwell in hyperendemic malaria of west Afric, but it's not suitable to be given anti-malaria cure immediately when their RDT to plasmodium are negative. It should be rechecked RDT everyday. Anti-malaria cure must be executed immediately when RDT turns positive. Generally, the patient might have suffered from malaria if RDT turns to positive inside 4 day from the first visit, and should be excluded if beyond 5 days. It maybe be infected after the first visit when patients' RDT turn to positive later. Malaria's early diagnosis is difficult and missed diagnosis or misdiagnosis maybe inevitable. It will not affect prognosis if anti-malaria cure is executed immediately after RDT to plas-modium shows positive. It's not suitable to adopt anti-malaria cure to all patients who are suspected malarial but whose RDT still show negative.
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