熱帯熱マラリア治療における開始遅延の意義

Abstract

We have previously reported that there exists a time limit for effective treatment of falciparum malaria. In short, four days after the onset of the illness was found to be the time limit beyond which severe, life-threatening complications may develop.In order to elucidate the level of laboratory variables beyond which the patient's prognosis is poor, we examined the correlation between time lag in days vs maximum parasite count, minimum red blood cell (r.b.c.) count, minimum hemoglobin (Hb), maximum blood urea nitrogen (BUN) and creatinine concentration of each patient during the period of admission. A linear correlation was found between time lag (x) and the maximum parasite count in log units (y), y= 4.031+0.124x, r =0.3579. All variables among patients whose treatment was started after 5 to 11 days of time lag (6th to 12th day of illness) were significantly worse than the variables of patients whose treatment was started after only 1 to 4 days of lag time. However, the most conspicuous change was observed in the abrupt increase of BUN and creatinine in the members of the late-treatment group : the mean BUN and creatine levels in the early and late treatment groups were 16.0 vs 57.1 and 1.2 vs 3.4 mg/dl (p <0.01), respectively. The mean parasite counts of the early and late treatment groups were 23, 400 vs 69, 200/μl of blood (p < 0.05), while the mean r. b. c. count and Hb concentration of the two groups were 3.81 vs 3.28 million per μl and 12.4 vs 10.0 g/dl (p<0.01), respectively., BR.In addition to the level consciousness of the patient, special attention should be paid to kidney function in the treatment of falciparum malaria patients whose treatment is delayed beyond the 5th day of illness.