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我部地处高疟地区,绝大部分疟疾病例的临床表现典型或较典型,诊断较容易,但有小部分病例的临床表现特殊,极易误诊。1978～1983年我们遇到了5例,开始全部误诊为其它病。现加以整理分析,以期提高对此种疟疾的诊断率。1.表现为急性肝炎样:患者女,16岁。突然畏寒发热,右上腹胀痛,食欲减退,恶心呕吐,小便深黄。近来无急性肝炎患者密切接触史。检查巩膜轻度黄染,肝肋下2指,有触痛、叩击痛,尿胆红素+,血清黄疽指数15单位,SGPT110单位(45单位以下为正常),以急性肝炎收留入所。入所后仍有畏寒发热,肝脾进行性肿大,血片找到疟原虫,改抗疟治疗。服氯喹后未再发热,黄疸消退。服药后1周,肝脾肿大消退,查肝功能正常。
My department is located in the high malaria area, most of the typical clinical manifestations of malaria cases or more typical, the diagnosis easier, but a small number of cases of special clinical manifestations, easily misdiagnosed. From 1978 to 1983, we encountered 5 cases and began to misdiagnose them as other diseases. Now to be analyzed, with a view to raising the diagnosis of malaria rate. 1. The performance of acute hepatitis-like: female patient, 16 years old. Sudden chills and fever, right upper quadrant pain, loss of appetite, nausea and vomiting, dark yellow urine. Recently there is no history of close contact with patients with acute hepatitis. Check sclera mild yellow dye, liver ribs under 2 fingers, tenderness, percussion pain, urinary bilirubin +, serum jaundice index 15 units, SGPT110 units (45 units following the normal), admitted to the hospital with acute hepatitis. After admission there is still chills and fever, liver and spleen progressive swelling, blood film found in malaria parasites, anti-malaria treatment. After taking chloroquine no more fever, jaundice subsided. One week after taking the medicine, the hepatosplenomegaly will regress and the liver function will be normal.