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Abstract: The patient had lived and worked in Africa for 2 years, and after returning to China, she developed fever with a maximum temperature of 39.8℃, fear of cold and chills 2 weeks before her admission to the hospital. After the peripheral blood smear was drawn, Plasmodium falciparum cycloplasma was found, and the diagnosis of falciparum malaria was clearly made. After treatment with relevant drugs, the patient’s body temperature returned to normal, and the hemoglobin rose to 95g/L after 2 weeks.
[Basic information] Male, 46 years old
Disease Type】Falciparum malaria
Hospital】Huashan Hospital of Fudan University
Date of consultation】March 2021
Treatment plan】Medication (hydroxychloroquine sulfate tablets) + rehydration therapy (glucose injection + sodium lactate Ringer injection)
Treatment period】7 days of inpatient treatment, followed by outpatient review after 2 weeks
Effectiveness】The patient’s condition was cured
I. Initial consultation
The patient was in good health and had lived and worked in Africa for 2 years before returning to China more than a month ago. During his stay in Africa, he had intermittent fever, but his temperature returned to normal without treatment, so he did not pay attention to it. Two weeks before admission, he had a recurrent fever with marked chills and chills, with a maximum temperature of 39.8°C. The temperature was maintained for 3-5 hours and then the fever subsided with profuse sweating. He was treated with cefazolin sodium by injection for 2 days, and was admitted to our outpatient clinic. Considering that the patient had a history of living in Africa, he had fever with chills and chills, and the possibility of malaria was high, he was immediately admitted to the ward for diagnosis and treatment.
II. Treatment process
The patient’s blood was drawn and sent to the laboratory for Plasmodium falciparum immediately after admission, and the routine blood test showed anemia, hemoglobin: 78g/L. Ultrasound showed enlarged liver and spleen, and liver function showed elevated glutamic transaminase and glutamic oxalacetic transaminase. The body temperature dropped significantly on the same day and returned to normal three days later.
Treatment effect
After treatment with hydroxychloroquine sulfate tablets, the patient’s body temperature dropped significantly on the same day, and returned to normal after 3 days. After 1 week of treatment, the patient’s general condition was stable and he was discharged from the hospital. 2 weeks later, hemoglobin rose to 95g/L and liver function returned to normal.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but as a parasite-induced infectious disease, falciparum malaria is mainly transmitted by mosquito bites, so during the recovery period, mosquito nets and liquid mosquito incense should be used to repel and prevent mosquitoes from spreading the disease to others. In addition, after discharge from the hospital, patients are advised to monitor their condition, such as the emergence of uncomfortable symptoms, to promptly seek medical examination. Pay attention to adjust lifestyle in daily life and maintain clean and hygienic habits.
V. Personal insight
Pernicious malaria is currently a rare local case in China, and is mostly an imported case. In this case, the patient returned from Africa, which is an endemic area for falciparum malaria. Combined with the patient’s chills and shivering with high fever followed by profuse sweating, the clinical manifestation was consistent with falciparum malaria, so the department conducted peripheral blood smear to find Plasmodium falciparum at the first time, and quickly obtained a clear diagnosis and timely treatment to prevent the patient’s condition from worsening and causing liver and kidney insufficiency, and the patient’s condition was cured after treatment.