【病例讨论】发热，寒战，间歇性呕吐，血涂片异常（答案已经公布）
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答案在1周后揭晓，届时，将公开所有站友的发言。
A 10-year-old boy presented in the emergency department with fever, chills, and recent episodic vomiting. He had immigrated from Nigeria 3 days before the admission. Laboratory results included notable leukopenia, thrombocytopenia, and anemia. His C-reactive protein concentration was 13.1 mg/dL (reference interval,0.5 mg/dL). The following image was seen on a thin smear .
10岁男孩，因发热，寒战，间歇性呕吐到急诊科求治。他三天前刚刚从尼日利亚回来。实验室检查显示：白细胞减少，血小板减少，贫血。CRP水平为13.1 mg/d（参考范围为小于或等于0.513.1 mg/d）.外周血图片镜检发现异常，如下图：
问：
1. What was the organism in the image that played a pivotal role in the transmission of his disease?
1，图像中的病原体与疾病的发生有关，这是什么病原体？
2. What enzyme deficiency can induce hemolysis in patients when they are administered a common drug to treat
this medical condition?
2，采用常规药物治疗该病时，患者什么酶的缺陷会导致溶血？
3. What is the proposed relationship between this child's anemia and the C-reactive protein concentration?
3，该儿童贫血和CRP水平之间可能存在什么关系？
＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝
答案：
This patient had Plasmodium falciparum infection. The images show the gametocytes, the sexual form of the parasite by which it is transmitted from hu mans to mosquitoes, its primary host.
这个病人是疟原虫感染，图片中显示的是配子体，疟原虫的生活周期主要是在任何蚊子之间传播。
Primaquine is the recommended treatment for malaria; however, primaquine can induce hemolysis in glucose-6-phosphate dehydrogenase–deficient individuals （1）
伯氨奎是治疗疟疾感染的药物，但是在G6PD缺乏的病人中，这种药物可以引起 溶血。
C-reactive protein has been shown to bind differently to diseased erythrocytes, activating complement-mediated hemolysis and facilitating clearance of the infected cells （2）
CRP可以与病态红细胞结合，激活补体系统，导致溶血，以便于清除被感染的细胞。
参考文献：
1，Piyaphanee W, Krud*** S, Tangpukdee N, Thanachartwet W, Silachamroon U, Phophak N, et al. Emergence and clearance of gametocytes in uncomplicated Plasmodium falciparum malaria. Am J Trop Med Hyg 2006;74:432–5
2，Ansar W, Bandyopadhyay SM, Chowdhury S, Habib SH, Mandal C. Role of C-reactive protein in complement-mediated hemolysis in Malaria. Glycoconj J 2006;23:233–40
连接：
http://www.clinchem.org/cgi/content/full/57/3/533
答案在1周后揭晓，届时，将公开所有站友的发言。
A 10-year-old boy presented in the emergency department with fever, chills, and recent episodic vomiting. He had immigrated from Nigeria 3 days before the admission. Laboratory results included notable leukopenia, thrombocytopenia, and anemia. His C-reactive protein concentration was 13.1 mg/dL (reference interval,0.5 mg/dL). The following image was seen on a thin smear .
10岁男孩，因发热，寒战，间歇性呕吐到急诊科求治。他三天前刚刚从尼日利亚回来。实验室检查显示：白细胞减少，血小板减少，贫血。CRP水平为13.1 mg/d（参考范围为小于或等于0.513.1 mg/d）.外周血图片镜检发现异常，如下图：
问：
1. What was the organism in the image that played a pivotal role in the transmission of his disease?
1，图像中的病原体与疾病的发生有关，这是什么病原体？
2. What enzyme deficiency can induce hemolysis in patients when they are administered a common drug to treat
this medical condition?
2，采用常规药物治疗该病时，患者什么酶的缺陷会导致溶血？
3. What is the proposed relationship between this child's anemia and the C-reactive protein concentration?
3，该儿童贫血和CRP水平之间可能存在什么关系？
＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝
答案：
This patient had Plasmodium falciparum infection. The images show the gametocytes, the sexual form of the parasite by which it is transmitted from hu mans to mosquitoes, its primary host.
这个病人是疟原虫感染，图片中显示的是配子体，疟原虫的生活周期主要是在任何蚊子之间传播。
Primaquine is the recommended treatment for malaria; however, primaquine can induce hemolysis in glucose-6-phosphate dehydrogenase–deficient individuals （1）
伯氨奎是治疗疟疾感染的药物，但是在G6PD缺乏的病人中，这种药物可以引起 溶血。
C-reactive protein has been shown to bind differently to diseased erythrocytes, activating complement-mediated hemolysis and facilitating clearance of the infected cells （2）
CRP可以与病态红细胞结合，激活补体系统，导致溶血，以便于清除被感染的细胞。
参考文献：
1，Piyaphanee W, Krud*** S, Tangpukdee N, Thanachartwet W, Silachamroon U, Phophak N, et al. Emergence and clearance of gametocytes in uncomplicated Plasmodium falciparum malaria. Am J Trop Med Hyg 2006;74:432–5
2，Ansar W, Bandyopadhyay SM, Chowdhury S, Habib SH, Mandal C. Role of C-reactive protein in complement-mediated hemolysis in Malaria. Glycoconj J 2006;23:233–40
连接：
http://www.clinchem.org/cgi/content/full/57/3/533
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