GB 15989-1995 Diagnostic criteria and treatment principles for malaria
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of management of malaria
GB15989—1995
This standard is formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and the Measures for the Implementation of the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases. 1 Subject matter and scope of application
This standard specifies the diagnostic criteria and treatment principles of malaria. This standard applies to the diagnosis and treatment of malaria by various epidemic prevention and medical and health institutions at all levels. 2 Diagnostic principles
Diagnosis is made based on the history of accommodation in the malaria area, clinical symptoms such as regular chills, fever, and sweating at the onset of the disease, signs such as splenomegaly, as well as the results of etiological examinations and serum immunological examinations. 3 Diagnostic criteria
3.1 Stayed in the malaria epidemic area during the malaria transmission season, or had a history of blood transfusion. 3.2 Intermittent and regular attacks, once a day, every other day, or every two days. There are clinical symptoms such as chills, fever, and sweating during the attack. Multiple attacks may cause splenomegaly and anemia. Severe cases may develop coma and other symptoms (see Appendix C for details). 3.3 Anti-acne drugs are used for presumptive treatment, and symptoms are controlled within 3 days. 3.4 Indirect fluorescent antibody test or enzyme-linked immunosorbent assay antibody is positive (see Appendix B for details). 3.5 Plasmodium is found in blood smears. Its types include Plasmodium vivax, Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale (see Appendix A for details). Suspected cases: meet 3.1 and 3.2.
Clinical diagnosis: Suspected cases add 3.3 or 3.4. Confirmed cases: Suspected cases add 3.5. According to the type of protozoa found, it is divided into Plasmodium vivax, Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale. 4 Treatment
4.1 Treatment
4.1. 1 Treatment of varicella, varicella and ovoid chloroquine 1.2~~1.5g for 3 days (0.6g on the first day, 0.3 or 0.45g on the second and third days), plus primaquine 90~~180mg for 4~8 days (22.5mg per day).
4.1.2 Treatment of malignant ulcer
~4.1.2.1 Treatment of malignant ulcer in areas without resistance to chloroquine 1.2~1.5g for 3 days (0.6g on the first day, 0.3 or 0.45g on the second and third days), plus primaquine 67.5mg for 3 days (22.5mg per day). 4.1.2.2 Treatment of malignant tumors in areas resistant to chloroquine: One of the following regimens: Piperaquine 1.5 g divided into 3 days, plus primaquine 45 or 67.5 mg divided into 2 or 3 days; Pyronaridine 1.2 g plus sulfadoxine 1.0 g divided into 2 days, plus primaquine 45 or 67.5 mg divided into 2 or 3 days; Pyronaridine 0.8-1.0 g plus sulfadoxine 1.0-1.5 g plus pyrimethamine 50-75 g divided into 2 days mg, all divided into 2 days; Artesunate sodium 600 mg5 divided into 5 days (100 mg × 2 times on the first day, 50 mg × 2 times per day on the 2nd to 5th day), plus primaquine 67.5 mg divided into 3 days (all for adults).
4.1.3 Presumptive treatment of suspected cases
Adult dose of chloroquine 0.6 g taken at a time, in chloroquine-resistant areas, use piperaquine 0.6 g taken at a time. After diagnosis, treat according to 4.1.1 or 4.1.2. 4.1.4 Anti-recurrence treatment of vivax carcinoma
Before the epidemic season, for those with a history of the disease within 1 or 2 years, adults should take 100 mg of pyrimethamine in two divided doses and 90 mg of primaquine in four divided doses. 4.1.5 Treatment of severe cases (see Appendix C for details) 4.1.5.1 Use sodium succinate or pyrimethamine or formaldehyde or quinine dihydrochloride injection for anti-acne treatment. 4.1.5.2 Infusion, vitamin supplementation, and supportive and auxiliary treatment. 4.1.5.3 Symptomatic treatment and complication management. 4.2 Preventive medication
In highly epidemic areas, for children, construction workers, residents in epidemic areas and floating population, during the epidemic season, adults should take 50 mg of pyrimethamine and 22.5 mg of primaquine at one time, and pregnant women should take 0.3 g of chloramphenicol or piperaquine at one time, both once every 10 days. In chlorine-resistant areas, use piperaquine 0.6g, or sulfadoxine 500mg plus pyrimethamine 37.5mg, once every 10 days, and take it for 2 consecutive days for the first time. 4.3 Mosquito control
In highly prevalent areas or epidemic points, use DDT (2g/m2) to spray houses and livestock sheds with residual spraying. In areas where mosquito nets are commonly used, use cypermethrin (10-20mg/m2) or dichlorophenoxyacetin (200-300mg/m2) to soak (or spray) mosquito nets. 4.4 Mosquito prevention
It is recommended to use mosquito nets and mosquito coils, use wild plants such as wormwood and mugwort to fumigate mosquitoes, and install screen windows and screen doors if conditions permit. Change the habit of sleeping outdoors to reduce mosquito bites.
4.5 Environmental management
Combine farmland water conservancy and new rural construction, fill potholes, remove stagnant water, level fields, repair ditches, and deepen water storage. In areas with conditions, fish farming or moist irrigation is used in rice fields. In areas where Anopheles dirus is the vector, the shrub forests around the village are developed in combination with production. 323
A1 Blood smear examination
GB15989--1995
Appendix A
Pathological examination
(Supplement)
A1.1 Gibbs solution staining-optical microscope (oil immersion lens) examinationA1.1.1 Preparation of blood smears Thin blood film and thick blood film are smeared on a clean slide. Blood is usually collected from the earlobe or finger (blood can be collected from the heel for infants). First disinfect the blood collection site with an alcohol cotton ball, then quickly pierce the person with a disposable lancet (or use a half-broken water-dip pen tip instead, but it must be boiled and disinfected after each use), and gently press to squeeze out the blood. Take a small amount (0.5-1.0 μL) of blood from the middle of the edge of the slide and push it on the slide to form a thin blood film. Then use a corner of the slide to take about 4-5 μL of blood (a drop of blood the size of a match head) and apply it to the appropriate position on the same slide to form a circular thick blood film with a diameter of 0.8-1.0 cm. Dry naturally and number the thin blood film with a pencil or on the back of the slide with a special crayon. A1.1.2 Blood staining The staining solution is prepared with 10g of Gibbs stain powder, 500mL of neutral glycerol and 500mL of pure methanol. When preparing, put Gibbs stain powder in a large mortar, gradually add a small amount of glycerol, grind it thoroughly, put it in a colored glass bottle, wash out the glycerol stain in the mortar with methanol several times, pour it into the bottle and shake it, leave it at room temperature for 3-5 days, and it can be used. Before staining, fix the thin blood film with methanol, dilute Giemsa stain with water at pH 7.0-7.2 to make a 3% dilution, insert the blood film into the staining jar for staining, or use a dropper to drop the dilution on the thick and thin blood films, and stain for 30 minutes. If rapid staining is required, add 3 drops of Giemsa stain to 2 mL of water and stain for 6 minutes. Or add a few drops of water to the thick blood film to dissolve the hemoglobin and then add the stain, which will have a better effect. After staining, rinse gently with water and insert it on a glass slide to dry. A1.1.3 Microscopic examination of blood film Drop a little tar on the stained blood film and examine it with an optical microscope (oil lens). Thick blood film should be examined mainly, and thin blood film is mainly used for protozoan species identification and protozoan density counting. After staining, the nucleus of malarial parasites is red and the cytoplasm is blue. Except for the ring body, brown parasite pigment can be found in all other stages of parasites. For patients with current symptoms, at least 100 thick blood film fields should be examined. For patients with parasites, the entire thick blood film should be examined. If no parasites are found, it is considered negative. The density of parasites in each microliter of blood is estimated by the average number of parasites per 100 red blood cells in the thin blood film or the average number of parasites per 100 white blood cells in the thick blood film. A1.2 Wright's solution staining - optical microscope (oil lens) examination A1.2.1 For blood smear preparation, refer to A1.1.1.
A1.2.2 Blood smear staining Use 0.2g of Wright's stain powder, place it in a mortar, add 3mL of neutral glycerol, grind it thoroughly, then add a small amount of methanol to the mortar to wash away the stain, pour it into a colored glass bottle, and then add methanol to the mortar to rinse until 100mL of methanol is used up. Shake well and filter it before use. When staining, first draw a horizontal line between the thick and thin blood films with a crayon, add 2 to 3 drops of water to the thick blood film to dissolve the hemoglobin, add about 1 mL of Wright's stain directly to the thin blood film and stain for 2 minutes, then add an equal amount of water to the thin blood film to dilute it and lead it to the thick blood film, so that the thick and thin blood films are stained for another 5 to 6 minutes, washed and dried. This method is not suitable for staining a large number of blood films, but the staining time is short and it is mostly used for outpatient testing in hospitals.
A7.2.3 Blood film microscopy, see A1.1.3.
A1.3 Fluorescein acridine orange staining - fluorescence microscope examination A1.3.1 Preparation of blood smears See A1.1.1, but the thick blood film should be slightly thinner than the thick blood film stained with Gibson's solution, that is, 3μL of blood is used to smear a sub-thick blood film with a diameter of 1.2-1.5cm; the thin blood film should not be too thin, and the film can be pushed at a 45° angle to form a thicker thin blood film. A1.3.2 Blood film staining: First use methanol to fix thin blood films, and use water to dissolve hemoglobin in thick blood films. Use 1g of acridine orange and 100mL of pH 6.5~7.0 phosphate buffer to prepare 1% acridine orange stock solution. When staining, add 0.1mL of acridine orange stock solution to 9.9mL of normal saline to make a 1/10,000 dilution. Use a dropper to take 2~3 drops of the dilution on the blood film, stain for 40~60s, and cover with a glass slide. A1.3.3 Blood film microscopy: Use a fluorescent microscope (or an ordinary optical microscope with a simple fluorescent light source device instead) in a darkroom for examination. The nuclei of protozoa and white blood cells show yellow-green fluorescence, and the cytoplasm shows orange-red fluorescence. A2 Bone marrow puncture
Perform according to hospital routine. This method is generally not suitable for the diagnosis of sores, and is only used for differential diagnosis in special circumstances. 324
B1 Indirect fluorescent antibody test (IFAT)
GB15989—1995
Appendix B
Serum immunological examination
(Supplement)
B1.1 Preparation of antigen slices Cynomolgus protozoa is often used as a substitute antigen. Rhesus monkeys are infected with Cynomolgus protozoa. When the red blood cell infection rate exceeds 2% and most protozoa are in the early schizont stage, blood is collected, anticoagulated with heparin, centrifuged at 2000r/min for 15min, the plasma is discarded, 5 times the volume of 0.01mol/L phosphate buffered saline (PBS) with pH 7.2 is added, mixed and centrifuged again, the supernatant is discarded, and the washing is repeated 3 to 4 times. The cell precipitate is restored to the original blood volume with PBS and then mixed into a suspension so that there are 5 to 8 schizonts or large trophozoites in each field of view of the thick blood film. Take about 10μL of the suspension and place it on the end of a clean glass slide, push it to form a 6.0cm×1.5cm long sub-thick blood film, and place it in the room temperature to dry or blow dry. Wrap it in paper and place it in a sealer with a desiccant. The validity period is 1 year at -20℃ and 3 months at 4℃. When using in vitro cultured malignant protozoa to prepare antigen slices, the protozoa should be collected and cultured when the red blood cell infection rate is above 4% and the schizonts are the main ones. The preparation method is the same as before. B1.2 Collection, transportation and storage of blood samples Serum and filter paper dried blood drops can be used. The former is obtained by separation of whole blood without anticoagulant, can be transported and stored for a short period of time at 4C, and can be stored for about 2 years at -20℃, but repeated freezing and thawing should be reduced to avoid affecting the activity of antibodies. The latter cuts the filter paper into 10cm×2cm pieces, presses out a circular imprint with a diameter of 1.2cm on the filter paper, takes blood from the earlobe or finger of the subject to fill the circle, and the volume is about 20μL (equivalent to 10μL of serum), numbers it, and then dries it in the shade, and puts it in a sealed plastic bag with a desiccant. It can be stored for half a year at 4℃, and for 2 years at -20℃.
B1.3 Operation method The test serum is diluted 1:10 or 1:20 with 0.01mol/LPBS at pH7.2, or the blood sample part of the filter paper is cut into pieces, placed in a well with 0.1 or 0.2mLPBS, and soaked at 4C overnight to obtain a serum dilution equivalent to 1:10 or 1:20. For blood samples with positive reactions at 1:10 or 1:20 dilutions, continue to dilute them in multiples (1:40, 1:80) for testing until they become negative. The final positive dilution is the endpoint titer. The antigen slices taken out of the refrigerator should be dried immediately with an electric fan or opened in a plastic bag after warming up. Each antigen slice should be divided into several small grids with a special wax pen. A blood sample or a titer should be added to each grid. A reference positive and negative serum and a PBS blank control should be set for each batch of tests. After adding serum, the slices should be moved into a 37°C wet box. After 30 minutes, they should be taken out and slowly rinsed with PBS and then placed in a jar with PBS for 5 to 10 minutes. After being rinsed with distilled water, they should be dried or blown dry. Then, 1:10 anti-human IgG fluorescent antibody diluted with PBS (or according to the product instructions) should be added dropwise to each grid, and the slices should be incubated at 37°C in a wet box for 30 minutes. Then, they should be washed and blown dry as described above, and the reaction results should be checked with a fluorescence microscope. B1.4 The reaction standard is distinguished by the fluorescence intensity and morphological structure clarity of the cytoplasm of schizonts and macrotrophozoites: no fluorescence is +, weak fluorescence and unclear morphological structure is +, weak fluorescence and clear morphological structure is +, and ++ ... Generally, a serum dilution of 1:20 or above is considered positive. B2 Enzyme-linked immunosorbent assay (ELISA)
B2.1 Soluble antigens: Collect the protozoa of the cynomolgus monkey according to the IFAT method, or collect the protozoa when the infection rate of the red blood cells of the malignant protozoa cultured in vitro is 4%8% and the schizonts are the main ones. Wash them by centrifugation for 3 to 4 times, and take the brown part of the upper layer of the precipitate and put it into the preservation tube. If the antigen is not prepared at that time, it can be stored in liquid nitrogen. If it is prepared immediately, put it in a 20℃ refrigerator and freeze and thaw it repeatedly for 3 times, each time for 1 hour, centrifuge to wash away the hemoglobin, collect the dark brown precipitate, add 10 times the amount of 0.01mol/LPBS with a pH of 7.4, and ultrasonicate it in an ice bath at a current intensity of 150mA for 3 times, each time for 1 minute, with an interval of 5 minutes, and centrifuge it at 10000r/min for 30 minutes. The supernatant is the soluble antigen. In order to determine the appropriate T for this antigen, under the conditions of the common concentration of the enzyme conjugate and the reference positive and negative serum dilution of 1:100, the antigen was diluted from 1:50, 1:100 to a total of 10 concentrations, coated on a plastic plate for detection, and the antigen dilution with an optical density (OD) value of 1.0 for the reference positive serum was selected as the appropriate antigen concentration. And it was divided into thin plastic tubes according to the common amount and stored in liquid nitrogen. B2.2 Operation method Use 0.05mol/L carbonate buffer at pH9.6 to dilute the antigen at the working concentration and coat the polystyrene plate, 200μl per well.. Overnight at 4C. The next day, the antigen solution was poured off and washed 3 times with pH7.4PBS/Tween 20 (PBS/T), each time for 5 minutes. Add serum to be tested diluted 1:100 with PBS/325
GB15989-1995
T, add 2 wells for each sample, 200uL per well, and place at 37℃ for 2h. After taking out, wash with PBS/T 3 times as described above, and let it dry. Add peroxidase-labeled anti-human IgG conjugate diluted with PBS/T (generally 1:1000), 200μL per well, and place at 37C for 2h. Wash 3 times as described above and let it dry. Add 200uL of hydrogen peroxide (HzOz) substrate system solution [10mg of o-phenylenediamine (OPD) + 25mL of pH5.0 citric acid-phosphate buffer, add 10μL of 33% H,O2 before use, store in the dark] to each well, and place at 37C for 30min. Add 50μL of 2mol/L sulfuric acid to each well to terminate the reaction. B2.3 Reaction standard: Read the OD value at 492nm with an enzyme-labeled colorimeter. Take the average OD value of the two wells of each sample. Before measuring the OD value, calibrate the zero point with 1/5 2mol/L sulfuric acid substrate solution. Usually, the OD value ≥ 0.4 is the positive threshold. In order to facilitate comparison and reduce errors, each plate should have a reference positive and negative serum and PBS/T blank control, and measure the OD value. The OD value of each blood sample was corrected according to formula (B1):
OD correction value=1www.bzxz.net
Sample OD value
Reference positive OD value
Attached solution preparation method:
pH7. 2 0. 01 mol/L. PBS
KH,PO4
Na2HPO,
Distilled water added to
pH 7. 4 PBS/T
Na2HPO,·12H,0
Tween 20
Distilled water added to
pH9.6 Carbonate buffer solution
NazcOs
Distilled water added to
pH 5.0 Citric acid-phosphate buffer
1.02g (or NazHPO12H202.58g)
1000ml
1000mL
1000mL
a. 0. 2mol/L NazHPO, : 12H,Ob. 0.1mol/L citric acid
35.8g/500mL distilled water
10.5g/500mL distilled water
Take a257mL+b243mL+distilled water 500mL and mix. 326
（B1）
C1 Treatment targets
GB159891995
Appendix C
Treatment of severe cases
(Supplement)
Confirmed cases present with coma, high fever (≥40°C), convulsions (occurring more than twice within 24 hours), severe anemia (hemoglobin ≤50g/L or 5g/dl.), urinary retention, dyspnea, hypotension (systolic blood pressure ≤6.67kPa or 50mmHg for children, systolic blood pressure ≤9.33kPa or 70mmHg for adults), hypoglycemia (whole blood glucose concentration ≤2.2mmol/l or 40mg/dL), hematuria, jaundice (serum bilirubin concentration ≥51.3μmol/L or 3.0mg/dL), acidosis [carbon dioxide binding capacity ≤13mmol/L or 30% (V/V)], among which - one or more symptoms. Mainly brain type caused by malignant protozoa. C2 Antisymptomatic treatment
Choose 1 or 2 of the following injections:
C2.1 Sodium cyanol succinate 60mg or 1.2mg/kg for adults each time, and 1.5mg/kg for children (each vial of cyanol succinate 60mg, add 0.6mL of 5% sodium bicarbonate injection when using, shake until completely dissolved), dilute to 6mL with 5% glucose solution and slowly inject intravenously. After the first injection, inject once every 4, 24, and 48 hours.
C2.2 Locaterol 3-6mg/kg for adults each time, 2-3mg/kg for children each time, dissolved in 5% or 10% glucose solution 250 or 500ml. Instillation, drip rate 40-60 drops/min for adults, reduced for children. It can be repeated after 8 hours, and the administration should be continued for 2 to 3 days. C2.3 Full methyl ether: 80 mg × 2 times or 160 mg divided into two gluteal muscles on the first day for adults, 80 mg each time on the second to fifth days, and 1.6 mg/kg each time for children.
C2.4 Quinine dihydrochloride: 20 mg/kg for the first dose, dissolved in 5% or 10% glucose solution or 500 mL of glucose saline, slowly dripped within 4 hours, repeated at 10 mg/kg every 8 hours, no more than 3 times within 24 hours. C3 Supportive and auxiliary treatment
C3.1 Infusion: 1500-2000 mL of infusion per day for adults, and the total amount should not exceed 3500 mL. Children should be infused 40-50 mL/kg per day, and the total amount should not exceed 70 mL/kg. The infusion is mainly 5% or 10% glucose solution, and saline should account for 1/5. C3.2 Vitamin supplementation: Vitamin C 2g/day intravenous injection for adults, vitamin B 100mg/day intramuscular injection, C4 Symptomatic treatment and treatment of complications
According to the symptoms, the following treatments are performed:
C4.1 Water loss: Estimate the amount of sweat, collect urine, and calculate the amount of fluid replacement. Adults should drink 1500-2000mL per day, and children should drink 40-50mL/kg of urine per day. Appropriate potassium supplementation.
C4.2 Acid-base imbalance: Dilute sodium bicarbonate 3 times with 5% glucose solution, and inject 60mL intravenously for adults each time, which can be repeated after 0.5-1h; or dilute sodium lactate 5 times with 5% glucose solution, and inject 100-200mL intravenously for adults each time. C4.3 Respiratory and heart failure: For patients with respiratory failure, increase the concentration of oxygen inhalation, and use coramine and lobeline for alternating injections. For heart failure, adults can use 0.25 mg of Convolvulus toxicus K each time, diluted with 20-40 ml of 5% glucose solution and slowly injected intravenously, or 0.4-0.8 mg of digoxin, diluted and slowly injected intravenously.
C4.4 Use mannitol in the early stage of renal failure, strictly limit the amount of infusion, and use peritoneal dialysis if necessary. C4.5 For pulmonary edema, take a semi-recumbent position, quickly increase the oxygen inhalation concentration, inject aminophylline intramuscularly or drip it into 5% glucose solution, 0.25-0.5 g each time for adults, or inject furosemide and other diuretics intravenously.
C4.6 For cerebral edema, adults can take 100-200 mL of sorbitol or mannitol each time, injected intravenously within 20 minutes, and repeated every 6-8 hours if necessary. 327
GB15989—1995
C4.7 For hypotension, drip norepinephrine 1 mg plus 5% glucose solution, or use other pressor drugs. C4.8 Circulatory failure: drip 6% low molecular weight dextran, 500mL for adults and 10~15mL/kg for children. Use with caution in patients with bleeding tendency.
C4.9 Hemolysis (black urine fever) is common in patients with specific constitutions lacking glucose-6-phosphate dehydrogenase (G-6-PD). Primaquine, quinine and sulfone drugs should be stopped immediately. Adrenal corticosteroids can quickly relieve the symptoms, and blood transfusion should be performed if necessary. C4.10 Severe anemia: patients with red blood cell count below 2 million/mm2 should be given blood transfusion immediately. C4.11 If hypoglycemia cannot be relieved by dripping 5% or 10% glucose solution, 50% glucose (1.0mg/kg) can be injected intravenously, but it should not be used frequently.
C4. 12 Convulsions: 1~3mg/kg of chlorpromazine or promethazine can be injected intramuscularly each time, or 0.2mg/kg of diazepam can be slowly injected intravenously. C4.13 Antibiotics are used to prevent bacterial infections. Appendix D
Instructions for the correct use of the standard
(reference)
D1 Parasitological diagnosis should be checked with thick blood film to reduce omissions. D2 All confirmed cases with parasitism found in blood smears, whether they are current cases or carriers, should be treated according to this standard. 3 Except for severe cases and cases of vomiting and severe diarrhea, other cases should be treated with oral antisymptomatic drugs as much as possible. D3
Additional instructions:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Parasitic Diseases, Chinese Academy of Preventive Medicine. The main drafters of this standard are Qian Huilin, Zhang Jia, and Wang Jie. This standard is interpreted by the Ministry of Health's technical coordination unit, the Office of Supervision and Administration of Communicable Disease Prevention and Control. 32812 For convulsions, 1~3mg/kg of chlorpromazine or promethazine should be injected intramuscularly each time. Diazepam 0.2mg/kg can also be slowly injected intravenously. C4.13 Antibiotics are used to prevent bacterial infections. Appendix D
Instructions for the correct use of standards
(reference)
D1 Parasitological diagnosis should be checked for thick blood films to reduce omissions. D2 All confirmed cases of parasitosis found in blood smears, whether they are current cases or carriers, should be treated according to this standard. 3 Except for severe cases and cases of vomiting and severe diarrhea, other cases should be treated with oral antisymptomatic drugs as much as possible. D3
Additional instructions:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Parasitic Diseases, Chinese Academy of Preventive Medicine. The main drafters of this standard were Qian Huilin, Zhang Jia, and Wang Jie. This standard is interpreted by the Ministry of Health's technical coordination unit, the Office of Supervision and Management of Communicable Disease Prevention and Control. 32812 For convulsions, 1~3mg/kg of chlorpromazine or promethazine should be injected intramuscularly each time. Diazepam 0.2mg/kg can also be slowly injected intravenously. C4.13 Antibiotics are used to prevent bacterial infections. Appendix D
Instructions for the correct use of standards
(reference)
D1 Parasitological diagnosis should be checked for thick blood films to reduce omissions. D2 All confirmed cases of parasitosis found in blood smears, whether they are current cases or carriers, should be treated according to this standard. 3 Except for severe cases and cases of vomiting and severe diarrhea, other cases should be treated with oral antisymptomatic drugs as much as possible. D3
Additional instructions:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Parasitic Diseases, Chinese Academy of Preventive Medicine. The main drafters of this standard were Qian Huilin, Zhang Jia, and Wang Jie. This standard is interpreted by the Ministry of Health's technical coordination unit, the Office of Supervision and Management of Communicable Disease Prevention and Control. 328
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