重症恶性疟为什么首选静脉青蒿琥酯而非奎宁？其杀虫优势体现在哪个虫期，疗程结束后还需警惕什么迟发不良反应？
Why is intravenous artesunate preferred to quinine in severe falciparum malaria, at which parasite stage lies its killing advantage, and which delayed adverse effect warrants vigilance after treatment?
青蒿琥酯对环状体期疟原虫起效快，可在虫体成熟并黏附微血管前将其清除，减少隔离化与微循环阻塞，原虫清除时间约为奎宁的一半；奎宁易诱发低血糖与心律失常。AQUAMAT试验显示青蒿琥酯使非洲重症患儿病死率相对下降约22%（8.5%对10.9%）。治疗后2–4周应随访血常规，警惕被抑制虫体清除后的迟发性溶血。
Artesunate acts rapidly against ring-stage parasites, clearing them before they mature and cytoadhere to microvessels, thereby limiting sequestration; parasite clearance takes about half the time seen with quinine, which also provokes hypoglycaemia and dysrhythmias. The AQUAMAT trial showed artesunate cut mortality in African children with severe malaria by roughly 22% relative (8.5% vs 10.9%). Follow-up blood counts two to four weeks later should watch for delayed haemolysis as suppressed parasites clear.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
Dondorp AM等，AQUAMAT试验，《柳叶刀》(Lancet) 2010年376卷；另见WHO《疟疾指南》2023年版
Dondorp AM, et al. Artesunate versus quinine in severe falciparum malaria in African children (AQUAMAT). Lancet. 2010;376(9753):1647-1657; WHO, Guidelines for malaria (2023).
#重症疟疾 #青蒿琥酯 #旅行医学
去非洲血吸虫病流行区旅行为什么不能在天然淡水湖河里游泳？回国后即使没有任何症状也建议做什么检查？
Why should travelers to schistosomiasis-endemic areas of Africa avoid swimming or wading in natural freshwater lakes and rivers, and what testing is recommended after returning home even without any symptoms?
流行区天然淡水体可含血吸虫尾蚴，接触皮肤数分钟内即可侵入引起感染，故预防要点是完全避免在湖泊河流中涉水游泳；出水后迅速用力擦干仅能减少而不能消除风险。多数早期感染无症状或仅轻度皮炎，虫卵沉积却可致血尿与肝脾损害。自流行区返回者建议末次暴露6–8周后查血清抗体，阳性者口服吡喹酮。
Natural freshwater in endemic areas may contain schistosome cercariae, which invade through intact skin within minutes of contact, so the core precaution is completely avoiding wading or swimming in lakes and rivers; briskly toweling off afterwards reduces but never eliminates the risk. Early infection is often silent or causes only itchy dermatitis, whereas deposited eggs gradually cause urinary bleeding and hepatosplenic disease. Returning travelers should have schistosomal serology about six to eight weeks after the last exposure and take praziquantel if positive.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 来源待核验 · Source pending review
来源 · Source
出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
美国疾控中心《国际旅行健康信息（黄皮书）》2024年版
CDC Health Information for International Travel 2024 (Yellow Book)
#血吸虫病 #旅行医学 #吡喹酮
为前往撒哈拉以南非洲疟疾高发区的旅行者制定化学预防方案时应考虑哪些个体因素？为什么有癫痫或精神疾病史的人不宜选用甲氟喹？
What individual factors guide the choice of malaria chemoprophylaxis for travelers to highly endemic areas of sub-Saharan Africa, and why should people with epilepsy or psychiatric history avoid mefloquine?
选药需权衡当地耐药状况、行程长短、妊娠与基础疾病及服药依从性：阿托伐醌-氯胍起效快，适合短程旅行；多西环素价廉，但须足量服完并注意光敏反应；甲氟喹每周一次便于坚持。然而甲氟喹可引起头晕、焦虑、精神病样发作乃至惊厥，癫痫和精神疾病史者禁用，心脏传导异常者也需慎用。各方案均应在出发前开始服药，并在离开疫区后继续规定疗程。
Drug choice weighs local resistance, trip length, pregnancy, comorbidities and adherence: atovaquone-proguanil acts quickly and suits short trips; doxycycline is cheap but must be completed in full course with attention to photosensitivity; mefloquine's weekly dosing aids compliance. Yet mefloquine can cause dizziness, anxiety, psychotic reactions and seizures, so it is contraindicated with epilepsy or psychiatric illness and used cautiously in cardiac conduction disease. Every regimen starts before departure and continues for the prescribed period after leaving the endemic area.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 已核验 · Verified 2026-11-04
来源 · Source
Hill DR 等,《The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America》,Clinical Infectious Diseases 43(12): 1519-1539,2006 (DOI: 10.1086/508782)
Hill DR, Ericsson CD, Pearson RD et al., 'The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America', Clinical Infectious Diseases 43(12): 1519-1539, 2006, DOI: 10.1086/508782
独立核验依据 · Independent verification: 核验依据 1 Crossref DOI 10.1086/508782
#疟疾 #化学预防 #旅行医学