Does This Patient Have Malaria?

被引:35
作者
Taylor, Steve M. [1 ,3 ]
Molyneux, Malcolm E. [5 ,6 ]
Simel, David L. [4 ,7 ]
Meshnick, Steven R. [1 ]
Juliano, Jonathan J. [2 ]
机构
[1] Univ N Carolina, Gillings Sch Global Publ Hlth, Dept Epidemiol, Chapel Hill, NC 27599 USA
[2] Univ N Carolina, Sch Med, Div Infect Dis, Chapel Hill, NC 27599 USA
[3] Duke Univ, Med Ctr, Div Infect Dis & Int Hlth, Durham, NC USA
[4] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[5] Coll Med, Malawi Liverpool Wellcome Trust Clin Res Programm, Blantyre, Malawi
[6] Univ Liverpool, Sch Trop Med, Liverpool L69 3BX, Merseyside, England
[7] Durham Dept Vet Affairs Med Ctr, Durham, NC USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2010年 / 304卷 / 18期
基金
美国国家卫生研究院;
关键词
PLASMODIUM-FALCIPARUM MALARIA; CLINICAL ALGORITHM; IMPORTED MALARIA; RETURNING TRAVELERS; PREDICTIVE FACTORS; GAMBIAN CHILDREN; UNITED-STATES; DIAGNOSIS; FEVER; AREA;
D O I
10.1001/jama.2010.1578
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Malaria commonly infects residents of and travelers to tropical regions. The clinical features of infection are notoriously nonspecific but have not been comprehensively evaluated. Objective To systematically review and synthesize data related to the predictive value of clinical findings for the diagnosis of malaria in endemic areas and in travelers returning from endemic areas. Data Sources, Study Selection, and Data Extraction The databases of MEDLINE and EMBASE (1950-July 2010) were searched to identify studies published in the English language of endemic and "imported" (acquired during travel) malaria. Additional studies were identified from reference lists. Studies were included that had patients suspected of having acute malaria (usually because of fever) and compared the presence or absence of clinical findings with blood smear confirmation. Two authors independently identified studies, appraised study quality, and extracted data on the patient population, outcome assessment, and clinical findings. Differences between reviewers were resolved by consensus. Data Synthesis Fourteen studies for endemic malaria were identified that met review criteria. Individual symptoms are of limited diagnostic utility but presence of splenomegaly (summary likelihood ratio [LR], 3.3; 95% confidence interval [CI], 2.0-4.7) or hepatomegaly (summary LR, 2.4; 95% CI, 1.6-3.6) make malaria more likely. Combinations of findings can affect the likelihood of malaria, but their performance varies by setting. Seven studies of imported malaria were identified. The presence of fever (LR, 5.1; 95% CI, 4.9-5.3), splenomegaly (summary LR, 6.5; 95% CI, 3.9-11.0), hyperbilirubinemia (LR, 7.3; 95% CI, 5.5-9.6), or thrombocytopenia (summary LR, 5.6; 95% CI, 4.1-7.5) make malaria more likely. Conclusions In endemic areas, the likelihood of malaria is increased by the presence of splenomegaly and hepatomegaly but individual findings are of limited utility and cannot reliably exclude malaria; combinations of findings may be useful to stratify risk in patients. In returning travelers, the clinical assessment can provide substantial diagnostic benefit, although all patients still require laboratory testing because malaria can be rapidly fatal. JAMA. 2010;304(18):2048-2056 www.jama.com
引用
收藏
页码:2048 / 2056
页数:9
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