In Kyiv, at the end of April, a case of death from malaria was recorded! The Epidemiological Service calls on all medical institutions in Kyiv and Ukraine to be vigilant, because during the holiday season, when our citizens travel to different countries, there is a high probability of contracting them with various infectious diseases, including malaria.
"About a lethal case of tropical malaria in Kyiv"
According to the information of the head of the Main Directorate of the State Sanitary and Epidemiological Service in Kyiv dated May 20, 2015, No. 1953, on April 20, 2015, a fatal case of tropical malaria was registered in Kyiv in a patient, a UN peacekeeper, who arrived from Côte d'Ivoire.
According to the results of an epidemiological investigation it was established that a resident of Kiev, a police lieutenant colonel, was at the UN mission in Côte d'Ivoire from December 2012 to 2015. He arrived in Kyiv on 04/04/2015.
I fell ill on 04/10/2015, when headaches, weakness began to bother me, body temperature increased to 38.5 °; C. Subsequently, convulsions appeared, periodically lost consciousness.
04/13/2015, the patient went to one of the private medical clinics in Kyiv, where he was examined, diagnosed with SARS, acute pharyngitis, laboratory tests are recommended, incl. screening for malaria.
It was also established that on April 13, 2015, laboratory tests, namely, a biochemical blood test and X-ray of the chest organs, were carried out in another private medical clinic in Kyiv. According to the results of the research, hyperbilirubinemia due to direct bilirubin, hyperenzymemia, signs of pneumonia in the lower lobe of the lung on the left were revealed. The results of laboratory and X-ray studies were provided personally to the patient on the same day.
14.04.2015 at 09.00 by ambulance the patient was hospitalized in the Alexander Clinical Hospital (ACH) in Kyiv. According to the results of the examination (blood pressure 80/50, 39 ° C, left-sided pneumonia, jaundice), taking into account the epidemiological history of the patient, the diagnosis was made at admission: "Malaria? Community-acquired lower lobar left-sided pneumonia, DN 0-I. Clinical diagnosis: " Tropical malaria, cerebral form, HDFN, oliguria, DIC syndrome". A laboratory blood test for malaria was ordered. The patient was hospitalized in the department of infectious anesthesiology and intensive care.
A laboratory study of the patient's blood products dated April 14, 2015 in the clinical diagnostic laboratory of the Kyiv City Hospital revealed rings, trophozoites, schizont, morula P.falciparum (+++++), which was confirmed in the parasitological laboratory of the State Institution "Kyiv City laboratory center of the State Sanitary and Epidemiological Service of Ukraine" and in the parasitological laboratories of the State Institution" Ukrainian Center for Disease Control and Monitoring of the Ministry of Health of Ukraine ».
Taking into account the clinical condition of the patient, the results of the laboratory investigation were prescribed a specific treatment for malaria (quinine 900 mg iv cr., Artemether 150 mg IM), dalacin, ceftriaxone. Intensive pathogenetic therapy and symptomatic treatment were carried out.
Due to the deterioration of the condition (coma 7-8 on the Glasgow scale, spontaneous breathing is ineffective, oliguria, a significant increase in the level of urea, creatinine), the patient was connected to a ventilator, according to indications, hemodialysis and blood transfusion were performed repeatedly.
Despite the volume of therapeutic measures, the patient's condition worsened, and on 04/20/2015. at 16.05. declared biological death.
Final clinical diagnosis:
a) the main one is tropical malaria, malignant course (cerebral form), cerebral coma II, acute renal and hepatic failure.
b) complications - acute kidney injury, anuria; acute respiratory distress syndrome; bilateral community-acquired pneumonia, DN stage III
c) concomitant - fatty hepatosis, arterial hypertension.
Thus, the reasons that led to the death are probably the neglect of the rules for personal chemoprophylaxis of malaria during the stay in the focus of malaria and upon arrival in Kiev, late seeking medical help for a patient with tropical malaria, lack of alertness for malaria among doctors of two private clinics in Kyiv, where the patient applied with signs of an infectious disease (4th day of illness). It was established that the following activities were not carried out by doctors of private clinics:
- The data on epidemiological anamnesis are not specified, the duration of stay abroad, the country of visit, the date of return to Kiev, illness, medical history are not specified;
- The diagnosis of "malaria?" has not been established, no emergency message has been sent to the territorial bodies of the State Sanitary and Epidemiological Service;
- Sampling and laboratory testing of blood for malaria have not been carried out;
- No recommendations provided for taking antimalarial drugs for preventive treatment after blood donation for laboratory testing for malaria;
- Immediate hospitalization of a patient with obvious signs of an infectious disease to the inpatient department of a healthcare facility has not been organized.
Based on the foregoing, we propose:
1. If patients seek medical help with complaints of fever, fever, malaise:
- Clarify data on epidemiological history, probability and duration of stay in tropical countries, date of return to Kiev;
- In the case of patients staying in tropical countries, if they have returned from them within the last 3 years, to establish the diagnosis "malaria? ", Immediately send an emergency message to the territorial bodies of the State Sanitary and Epidemiological Service;
- Immediately conduct blood sampling and laboratory testing for malaria;
- Advise on the use of antimalarial drugs for preventive treatment after blood donation for laboratory testing for malaria;
- Arrange immediate hospitalization of a patient with obvious signs of an infectious disease in an inpatient department of a healthcare facility.
2. Ensure the organization and conduct of activities to constantly improve the knowledge of medical workers on the diagnosis, treatment, prevention of malaria, primarily laboratory doctors, infectious disease specialists, therapists, family doctors, paying attention to the quality of diagnosis and treatment of malaria, incl. caused by several pathogens, the number of cases of which has been increasing in recent years.
3. Carry out sanitary and educational work among the population on the prevention of malaria, primarily among people leaving for the tropics and other malariogenic zones, in order to conduct high-quality chemoprophylaxis during their stay abroad and upon their return to Ukraine.
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