Analysis of one case of artemether-resistant severe falciparum malaria

Abstract

To analyze the clinical data of one case of artemether-resistant severe falciparum malaria in peacekeeping mission area in the Democratic Republic of the Congo in December 2019, so as to provide the reference for the treatment of falciparum malaria. The clinical history, laboratory diagnosis and treatment of one patient with artemether resistance in severe plasmodium falciparum malaria were reviewed. The patient, a Chinese engineer, had engaged in UN peace-keeping operation in the Democratic Republic of the Congo since Sep 23 2019. He was admitted to Chinese Level II Hospital on Dec 8, 2019 with the complaint of headache and weakness for 3 days, with fever and jaundice for 1 day. Plasmodium falciparum was diagnosed definitively by rapid diagnostic test (RDT) and blood film smear. Parasite density was 53 200 /μL on admission, then the parasite clearance rate was monitored by blood film smear. Artemether was intramuscularly injected once a day for two days. But the patient’s symptoms were not improved, and the parasite density was still high (36 380 /μL) on Dec 10, 2019. The possibility of resistance to artemether was considered, so artesunate was intravenously injected for anti-malarial treatment. Meanwhile the comprehensive treatment such as liver protection was continued. December 13, 2019, the patient’ s condition was improved, and the anti-malarial therapy was changed to oral compound dihydroartemisinin tablets. The parasitemia was undetectable since Dec 14, 2019. The patients were discharged on Dec 20, 2019, and followed up for 3 months without recurrence. The therapeutic efficacy for falciparum malaria has been severely threatened by artemisinin resistance, not only for malaria in peacekeeping mission area, but also for imported malaria. The timely diagnosis and treatment for falciparum malaria play a critical role, meanwhile the survey of artemisinin resistance should be emphasized. 摘要 ：收集刚果(金)维和任务区2019年12月收治的1例蒿甲醚耐药重症恶性疟病例诊疗过程中的临床和实验室 检验资料, 并进行相关分析, 为今后恶性疟疾的临床治疗提供思路。该患者为中国工兵, 自2019年9月23日参与联合 国刚果(金)维和行动。2019年12月8日患者因“头痛、乏力3 d, 发热伴皮肤及巩膜黄染1 d”就诊于中国二级医院。经 血涂片镜检为恶性疟疾, 疟原虫计数为53 200/μL。人院后予以蒿甲醚肌肉注射行抗疟治疗, 并通过血涂片监测疟原 虫清除率。2019年12月10日患者仍持续发热, 伴腹痛、呼吸急促, 血涂片疟原虫计数36 380/μL。考虑蒿甲醚耐药可 能, 改用青蒿琥酯静脉注射, 继续行保肝等综合治疗。2019年12月13日患者症状改善, 改用口服复方双氢青蒿素片治 疗。2019年12月14日患者血涂片疟原虫转阴, 并于2019年12月20日出院。随访3个月, 患者无发热等不适, 复査血 涂片阴性, 证实该疟疾病例已痊愈。青蒿素耐药性的发生, 给维和任务区及国内输人性恶性疟疾的治疗带来严重的威 胁 , 必须做到早发现、早诊断、早治疗 , 同时重视耐药性的监测。