در بيمار مشكوك به ابولا، بايد به فكر مالاريا بود: گزارش موردي

Considering the malaria is essential in a patient with suspected Ebola: case report

زمينه و هدف: ابولا از علل مهم تب‌های خونريزی‌دهنده می‌باشد. ميزان بالای مرگ و نبود درمان قطعی، اين عفونت را به صورت يك معضل خطرناك مطرح كرده است. ابولا در مراحل اوليه كه دارای علايمی مانند تب، بی‌اشتهايی و تهوع است می‌تواند با مالاريا اشتباه شود. معرفی بيمار: آقايی 54 ساله، كه هشت ماه پيش به سودان رفته بود، يك هفته پيش از بازگشت دچار احساس كسالت، تب و لرز شد. علايم بيمار تا چهار هفته ادامه يافت، در هفته آخر دچار هماچوری شد و در نهايت از بيمارستان ديگری با تشخيص احتمالی ابولا به مركز ما ارجاع شد. اما در لام خون محيطی گامتوسيت‌های مالاريای فالسيپاروم مشاهده گرديد. نتيجه‌گيری: ابولا می‌تواند در هر بيمار تب‌دار با سابقه‌ای از اقامت يا مسافرت به مناطق اندميك مورد شك قرار گيرد. اما عدم وجود شك بالينی به مالاريا در بيماران مشكوك به ابولا، ممكن است باعث اشتباه پزشك در تشخيص، درمان نادرست و مرگ بيمار گردد.

Background: One of the main reasons of hemorrhagic fevers is Ebola. The high rate of mortality and lack of definite treatment have been caused this infection to be a serious problem in the world. Ebola, especially in the early stages, when causes symptoms such as fever, anorexia and nausea, can be confused with malaria infection and conversely, severe malaria with Ebola. Plasmodium falciparum is an important cause of severe malaria that more than other types of plasmodium confused with Ebola. Case presentation: The patient is a 54-year-old man who had gone to Sudan about 8 months ago. The patient reported that fever, chills and headache had been started one week before traveling from Sudan to Iran and hematuria was added to his symptoms in third week of illness in Iran. He was referred to the emergency department with probable diagnosis of Ebola. Plasmodium falciparum gametocytes were revealed in his peripheral blood smear. Finally, he was treated with Coartem (artemether/lumefantrine) for malaria and after clinical improvement discharged to home with good condition. Conclusion: Ebola should be suspected in every patient with fever and a history of traveling to endemic areas. Considering the fact that in most areas where Ebola is endemic also malaria is common, lack of clinical suspicion to malaria causes that clinicians mistake malaria with Ebola. Necessary laboratory tests to rule out important differential diagnoses in patients with suspected Ebola virus contains: Peripheral blood smear for malarial parasite and blood culture and blood cell counts to investigate typhoid fever and other bacterial infections. Therefore, malaria should be considered as an important differential diagnosis in every patient suspected with Ebola.