227.4 📌 章末速蚘

  • Malaria: 5 species (P. falciparum most severe; vivax/ovale relapse via hypnozoites; knowlesi zoonotic SE Asia)
  • Anopheles mosquito vector; sporozoite → hepatocyte → merozoite → RBC → fever paroxysm
  • Classic triad: cold/hot/sweating stages; periodicity by species
  • Severe malaria: cerebral, anemia, AKI, ARDS, acidosis, hypoglycemia, shock, hyperparasitemia
  • Diagnosis: thick + thin Giemsa smears (q12h × 3 if neg), RDTs (HRP-2 + pLDH), PCR
  • Uncomplicated Tx: ACT (artemether-lumefantrine first-line)
  • Severe Tx: IV artesunate drug of choice (AQUAMAT trial); no steroid; ICU + supportive
  • Radical cure P. vivax/ovale: primaquine 14d or tafenoquine 300 mg × 1; G6PD test required; pregnancy contraindicated
  • Prophylaxis: Malarone, doxycycline, mefloquine, chloroquine (sensitive areas), tafenoquine
  • Vaccines: RTS,S/AS01 (2021) + R21/Matrix-M (2023, mass rollout 2024) — game changers for Africa
  • Resistance: artemisinin (kelch13) SE Asia + emerging Africa; chloroquine widespread P. falciparum
  • Mosquirix RTS,S 4-dose 36% efficacy; R21 75% efficacy (more effective + cheaper)
  • 95% global malaria mortality in Africa; 80% in children < 5
  • 盧醫垫 hint: returning traveler + fever → 立即 malaria smear + RDT; severe → IV artesunate without delay