Clinical Research On111Malaria Cases From A Large Hospital Of Hunan Province In The Last30Years

Objective:Through retrospective analysis on the clinical data of malaria cases collected from a large hospital of Hunan Province in the last30years, the author tried to find some changes or variations in epidemiology, clinical manifestations, laboratory findings, etiology and treatment of malaria. New insights about malaria of specific region would be helpful to guiding the clinical practice, prompting the diagnosis and treatment, and improving preventive strategies of malaria under the new situation.Method:1. Collecting the clinical data of malaria cases from1984to2013in the given hospital.2. Comparing the epidemiological changes of malaria in three periods of the last30years which were divided by ten years a group.3. Comparing the domestic cases with the foreign cases of malaria in the changes of clinical manifestations, laboratory findings, etiology and treatment.4. Statistical Methods:using two independent samples t-test or Wilcoxon test in measurement data; using the chi-square test in count data.Results:1.111malaria cases in total. 2. There were14malaria cases in group1984-1993, which contained14.3%of the foreign imported cases (2/14). In group1994-2003, there were29malaria cases which contained17.2%of the foreign imported cases (5/29). However in group2004-2013, there were68malaria cases which contained97.1%of the foreign imported cases (66/68). By comparing group1984-1993with group1994-2003, a significant increase of the foreign imported malaria cases was observed in group2004-2013(P<0.001).3. In all cases,plasmodium species of80malaria cases were clear.There were14malaria cases in group1984-1993, which contained78.6%of tertian malaria cases (11/14) and21.4%of falciparum malaria cases(3/14). In group1994-2003, there were20malaria cases which contained55.0%of tertian malaria cases(11/20) and45.0%of falciparum malaria cases(9/20). However in group2004-2013, there were46malaria cases which contained15.2%of tertian malaria cases(7/46),69.6%of falciparum malaria cases(32/46) and15.2%of the mixed infection cases(7/46).Comparing the three group cases,the difference of constituent ratio of plasmodium species were statistically significant (P<0.001).4. Comparison between38domestic cases and73foreign imported cases indicated that the incidence of intermittent fever and hidrosis dropped significantly (P<0.01) in the foreign imported cases. At the same time, the incidence of shivering in the foreign imported cases declined significantly (P<0.001). But the occurrence of Soy sauce-like urine, oliguria, jaundice and the altered mental status in the foreign imported cases increased significantly (P<0.05). 5. The levels of WBC count, total bilirubin, direct bilirubin, alanine aminotransferase and aspartate aminotransferase also significantly increased in the foreign imported cases when compared with the domestiac cases(P<0.05). But the levels of the platelet count and the albumin dropped much more in the foreign imported cases than those in the domestic ones (P<0.05).6. There was no significant difference in positive rates between the peripheral blood smear and bone marrow smear.7. P. falciparum infection alone and the mixed infection were more common in the foreign imported cases relative to the domestic cases (P <0.001)8. In the treatment, the main drugs used in clinical practice were artemisinin and its derivatives. The difference of curative effect was not observed between the domestic cases and the foreign imported cases.Conclusions:In recent ten years, the foreign imported cases of malaria increased significantly in Hunan Province.The atypical clinical cases and the severe cases of malaria increased, and the main pathogen was P. falciparum. Though there existed some changes in many aspects of malaria infection, the current anti-malarial drugs are still effective.