Adecuación del tratamiento de la malaria de acuerdo con los criterios de gravedad definidos por la Organización Mundial de la Salud en un país no endémico

IF 2.2 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica Pub Date : 2026-01-01 Epub Date: 2025-12-23 DOI:10.1016/j.eimc.2025.503051

María Asunción Pérez-Jacoiste Asín , Andrea Navarro Flores , Anatolio Alonso Crespo , Ana Pérez-Ayala , Irene Losada Galván , Begoña de Dios , Pilar Hernández-Jiménez , Manuel Gil-Mosquera , Francisco Jiménez-Morillas , Carlos Lumbreras , Manuel Lizasoain , Juan María Herrero-Martínez

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Abstract

Introduction

The number of cases of malaria is increasing in Spain due to tourism and migration. Unfamiliarity with this disease may lead doctors to misrecognize its severity and over-/under-treat it. We aimed to analyse the adequacy of treatment according to malaria severity.

Methods

Single-centre retrospective study at “Hospital 12 de Octubre” (Madrid). We identified all patients over 16-years-old with symptomatic malaria from January 2015 to December 2023. The severity of malaria was defined according to WHO criteria. Parenteral artesunate was the treatment of choice for severe malaria. Oral artemisinin combination or atovaquone/proguanil were used for non-severe malaria.

Results

We identified 64 patients (median age 39,5 years (IQR 32,25-47), 75% Visiting Friends and Relatives. Malaria was severe in 15 patients (23.4%). Antimalarial treatment was adequate to severity in 46 patients (71.8%). Three cases classified as severe malaria received oral treatment while 15 cases apparently non-severe received parenteral artesunate. Those who received oral treatment for severe malaria had been misclassified (mild epistaxis, chronic renal insufficiency, and 3.5% parasitaemia in an immigrant). Among those treated parenterally for non-severe malaria, four had oral intolerance and in the remaining eleven, there was an overuse of artesunate. The main reason for artesunate overuse was the presence of thrombocytopenia (median platelet-count: 33,000/mm3, IQR: 28,000-51,000/mm3).

Conclusions

Antimalarial treatments were mostly adequate, especially in severe cases. The most common reason for artesunate overuse was the presence of thrombocytopenia, which is not included in the WHO criteria for severe malaria.

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在非疟疾流行国家按照世界卫生组织确定的严重程度标准对疟疾进行适当治疗

由于旅游和移民，西班牙的疟疾病例数正在增加。对这种疾病的不熟悉可能导致医生错误地认识到其严重性，并对其治疗过度或不足。我们的目的是根据疟疾的严重程度分析治疗的充分性。方法在马德里“10月12日医院”进行单中心回顾性研究。我们确定了2015年1月至2023年12月期间所有16岁以上的有症状疟疾患者。疟疾的严重程度是根据世卫组织的标准确定的。静脉注射青蒿琥酯是治疗严重疟疾的首选方法。非重症疟疾采用口服青蒿素联合用药或阿托伐醌/普罗胍联合用药。结果64例患者，中位年龄39,5岁（IQR 32,25-47）， 75%访亲访友。重症疟疾15例（23.4%）。46例（71.8%）患者抗疟治疗足以缓解严重程度。3例重度疟疾患者接受口服治疗，15例明显非重度疟疾患者接受静脉注射青蒿琥酯治疗。接受口服治疗的重症疟疾患者被错误分类（轻度鼻出血、慢性肾功能不全和移民中3.5%寄生虫血症）。在接受非严重疟疾非肠外治疗的患者中，4人出现口服不耐受，其余11人出现过量使用青蒿琥酯的情况。过量使用青蒿琥酯的主要原因是存在血小板减少（血小板计数中位数：33,000/mm3, IQR: 28,000-51,000/mm3）。结论疟疾治疗大多是充分的，尤其是重症病例。过量使用青蒿琥酯的最常见原因是存在血小板减少症，而世卫组织的严重疟疾标准不包括血小板减少症。

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来源期刊

Enfermedades infecciosas y microbiologia clinica 医学-传染病学

CiteScore

2.10

自引率

8.00%

发文量

194

审稿时长

29 days

期刊介绍： Hoy está universalmente reconocida la renovada y creciente importancia de la patología infecciosa: aparición de nuevos agentes patógenos, de cepas resistentes, de procesos con expresión clínica hasta ahora desconocida, de cuadros de una gran complejidad. Paralelamente, la Microbiología y la Infectología Clínicas han experimentado un gran desarrollo como respuesta al reto planteado por la actual patología infecciosa. Enfermedades Infecciosas y Microbiología Clínica es la Publicación Oficial de la Sociedad Española SEIMC. Cumple con la garantía científica de esta Sociedad, la doble función de difundir trabajos de investigación, tanto clínicos como microbiológicos, referidos a la patología infecciosa, y contribuye a la formación continuada de los interesados en aquella patología mediante artículos orientados a ese fin y elaborados por autores de la mayor calificación invitados por la revista.