ZDRAVLJENJE TEŽKE OBLIKE MALARIJE
Ključne besede:
Plasmodium falciparum, težka oblika malarije, zdravljenjePovzetek
Izhodišča. Malarija predstavlja nujno bolezensko stanje, ker lahko naglo napreduje do težkih zapletov in smrti, če ni takoj in ustrezno zdravljena. Težko obliko malarije skoraj vedno povzroči Plasmodium falciparum. Incidenca vnesene malarije v razvitih državah narašča in število smrtnih primerov se kljub napredku v intenzivni medicini in kljub protimalaričnemu zdravljenju ne zmanjšuje. Klinično poslabšanje se običajno pojavi 3 do 7 dni po pojavu vročine. Zapleti prizadenejo živčevje, dihala, ledvice in/ali krvotvorni sistem. Pogosto se pojavita tudi acidoza in hipoglikemija.
Zaključki. V začetnem zdravljenju težke oblike malarije, ki jo je povzročil P. falciparum, praviloma uporabljamo intravenski kinin, medtem ko derivate artemisinina v začetnem zdravljenju priporočamo le v primeru odpornosti na kinin. Kakor hitro bolnik postane klinično stabilen in lahko požira, preidemo na oralno zdravljenje. Razvoj akutnega sindroma oteženega dihanja preprečujemo tako, da vzdržujemo znotrajžilni volumen na najnižji, še zadostni ravni za primerno sistemsko prekrvitev. Pričetek dializnega zdravljenja priporočamo pri akutni ledvični odpovedi zgodaj v poteku težke oblike malarije. Izmenjalna transfuzija krvi izboljša preživetje pri bolnikih s težko obliko malarije in hiperparazitemijo. Za zgodnjo diagnozo je pomembno, da upoštevamo možnost malarije pri vsakem bolniku z vročino, ki je v zadnjih letih potoval v endemsko področje.
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