Matthias Kästner, Christoph Josef Hemmer, E. C. Reisinger
{"title":"[胃肠道症状可能反映恶性疟原虫疟疾并发症]。","authors":"Matthias Kästner, Christoph Josef Hemmer, E. C. Reisinger","doi":"10.1055/a-2256-6589","DOIUrl":null,"url":null,"abstract":"HISTORY\n A 42-year-old female presented with a two-day history of vomiting, diarrhea, fever and chills. Two weeks before she had returned to Germany from a Safari in Tanzania. She had disregarded the recommendation to take antimalarial chemoprophylaxis.\n\n\nCLINICAL FINDINGS AND DIAGNOSIS\n The thin blood film showed Plasmodium falciparum-parasitized erythrocytes, and Plasmodium falciparum malaria was diagnosed. The full blood count showed thrombocytopenia and ultrasound imaging revealed splenomegaly. Initially the criteria for complicated malaria were not fulfilled.\n\n\nTHERAPY AND COURSE\n We started oral therapy with atovaquone/proguanil. The patient vomited the tablets twice. Therefore therapy was switched to intravenous artesunate. Subsequently, parasitemia dropped from 2.8 to 1.0 % within 22 hours. After 3 days of artesunate i. v., treatment could then be completed with oral atovaquone/proguanil, and the symptoms resolved.\n\n\nCONCLUSIONS\n Patients with malaria and persistent vomiting should be treated intravenously and monitored closely, as severe gastrointestinal symptoms may reflect impending organ failure. We therefore propose including persistent vomiting in the list of criteria for complicated malaria.","PeriodicalId":11370,"journal":{"name":"Deutsche Medizinische Wochenschrift","volume":null,"pages":null},"PeriodicalIF":0.6000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Gastrointestinal symptoms may reflect complicated falciparum malaria].\",\"authors\":\"Matthias Kästner, Christoph Josef Hemmer, E. C. Reisinger\",\"doi\":\"10.1055/a-2256-6589\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"HISTORY\\n A 42-year-old female presented with a two-day history of vomiting, diarrhea, fever and chills. Two weeks before she had returned to Germany from a Safari in Tanzania. She had disregarded the recommendation to take antimalarial chemoprophylaxis.\\n\\n\\nCLINICAL FINDINGS AND DIAGNOSIS\\n The thin blood film showed Plasmodium falciparum-parasitized erythrocytes, and Plasmodium falciparum malaria was diagnosed. The full blood count showed thrombocytopenia and ultrasound imaging revealed splenomegaly. Initially the criteria for complicated malaria were not fulfilled.\\n\\n\\nTHERAPY AND COURSE\\n We started oral therapy with atovaquone/proguanil. The patient vomited the tablets twice. Therefore therapy was switched to intravenous artesunate. Subsequently, parasitemia dropped from 2.8 to 1.0 % within 22 hours. After 3 days of artesunate i. v., treatment could then be completed with oral atovaquone/proguanil, and the symptoms resolved.\\n\\n\\nCONCLUSIONS\\n Patients with malaria and persistent vomiting should be treated intravenously and monitored closely, as severe gastrointestinal symptoms may reflect impending organ failure. We therefore propose including persistent vomiting in the list of criteria for complicated malaria.\",\"PeriodicalId\":11370,\"journal\":{\"name\":\"Deutsche Medizinische Wochenschrift\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Deutsche Medizinische Wochenschrift\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2256-6589\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Deutsche Medizinische Wochenschrift","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2256-6589","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
[Gastrointestinal symptoms may reflect complicated falciparum malaria].
HISTORY
A 42-year-old female presented with a two-day history of vomiting, diarrhea, fever and chills. Two weeks before she had returned to Germany from a Safari in Tanzania. She had disregarded the recommendation to take antimalarial chemoprophylaxis.
CLINICAL FINDINGS AND DIAGNOSIS
The thin blood film showed Plasmodium falciparum-parasitized erythrocytes, and Plasmodium falciparum malaria was diagnosed. The full blood count showed thrombocytopenia and ultrasound imaging revealed splenomegaly. Initially the criteria for complicated malaria were not fulfilled.
THERAPY AND COURSE
We started oral therapy with atovaquone/proguanil. The patient vomited the tablets twice. Therefore therapy was switched to intravenous artesunate. Subsequently, parasitemia dropped from 2.8 to 1.0 % within 22 hours. After 3 days of artesunate i. v., treatment could then be completed with oral atovaquone/proguanil, and the symptoms resolved.
CONCLUSIONS
Patients with malaria and persistent vomiting should be treated intravenously and monitored closely, as severe gastrointestinal symptoms may reflect impending organ failure. We therefore propose including persistent vomiting in the list of criteria for complicated malaria.
期刊介绍:
Ein Schwerpunktthema - verschiedene Perspektiven
Mit vielen praktischen Tipps und konkreten Handlungsanweisungen.
Kurz und prägnant: Aktuell informiert
Interessante Nachrichten für Sie zusammengefasst und von Experten kommentiert.
Fundiertes Fachwissen - für Einsteiger und Profis
Ein bunter Mix aus Übersichten, Fallbeispielen, Kasuistiken und Schritt-für-Schritt-Anleitungen.
Blick über den Tellerrand
Erweitern Sie Ihren Fokus über das reine Fachwissen hinaus mit "Medizin im Kontext".