Objective　To analyze the causes of death of one case of imported falciparum malaria in Guangxi Zhuang Autonomous Region in January 2023, to provide a reference for the prevention of fatal malaria cases. Methods Interviews were conducted with the doctors who received and consulted the patient, as well as the family members of the patient. Clinical data from the patient's diagnosis and treatment process were collected, and the patient's clinical records and epidemiological investigation data were analyzed. Results The patient, Mr. He, a 53-year-old male from Pingnan County, Guigang City, Guangxi Zhuang Autonomous Region, returned from working in Côte d'Ivoire, Africa, and entered Guangxi on December 26, 2022. He returned home after his centralized quarantine was lifted on January 3, 2023. On January 4th, 2023, the patient developed dizziness and vomiting, considering himself to a possible COVID-19 infection, he did not seek treatment. On the morning of January 6, the patient developed a fever (peak body temperature of 40 ℃), accompanied by fatigue and sore throat, and the preemptive symptoms were aggravated. The patient was admitted to the Guancheng Town Health Center with "Pneumonia" and treated with ribavirin, dexamethasone, ceftriaxone sodium, etc. On January 7, the patient again experienced a high fever (40 ℃) and was discharged to the Emergency Department of the First Affiliated Hospital of Guangxi Medical University. Upon admission, the patient's blood pressure was measured at 78/53mmHg, further comprehensive examination showed a decrease in platelets and abnormalities in liver and renal function, procalcitonin levels at 49.9 ng/mL. Chest CT showed pneumonia, and fluid supplements and antibiotics were given. On January 8, malaria parasites were found in the patient's blood smear, and the patient was diagnosed with malaria (not classified, confirmed as falciparum malaria on January 9th). The patient was recommended to transfer to the provincial malaria-designated hospital, but his family refused. On January 8 at 13:27, the patient excreted approximately 700 g of dark red bloody stools accompanied by blurred consciousness and received hemostasis treatment. After coordinating with multiple parties, four doses of "artemisinin injection " (60 mg/dose) were taken for treatment. At 18:59 on January 8, intravenous administration of 60 mg injectable Artesunate was given, accompanied by symptomatic treatment for fever reduction and rehydration. At 19:40, the patient developed severe hypoglycemia, and severe metabolic acidosis, and blood pressure continued to decrease despite the use of vasopressors. After comprehensive treatment at 3:00 am on January 9, the patient's condition continued to deteriorate, the patient's shock could not be corrected, he lapsed into a coma, and the family requested to be discharged from the hospital. The patient returned home at 7:00 am and died of multiple organ failure at 7:30 am. Conclusions For imported malaria, early and precise diagnosis based on epidemiological history, clinical symptoms, laboratory test results, early antimalarial treatment, and management of organ dysfunction are the keys to avoiding fatal outcomes.

Objective To investigate the prevalence of hepatitis D virus (HDV) infection among patients with chronic hepatitis B virus (HBV) infection in some regions of China. Methods Serum samples were collected from 3 131 patients with chronic HBV infection in 10 provinces, cities, and autonomous regions of China from March 2021 to June 2022, and anti-HDV IgG ELISA was used for the detection of all serum samples. Nested reverse transcription-polymerase chain reaction (nRT-PCR) was used to detect HDV RNA in anti-HDV IgG-positive samples, and the nRT-PCR amplification products of HDV RNA-positive samples were sequenced and analyzed to determine HDV genotype. The clinical features of anti-HDV IgG-positive patients were analyzed. The Mann-Whitney U rank sum test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results The positive rate of anti-HDV IgG in the 3 131 patients with chronic HBV infection was 0.70% (22/3 131), and that in the patients with chronic HBV infection in Inner Mongolia Autonomous Region, Xinjiang Uygur Autonomous Region, Beijing, and Hunan Province was 1.81% (16/886), 0.88% (2/226), 0.28% (2/708), and 1.00% (2/200), respectively; the patients with chronic HBV infection in Inner Mongolia Autonomous Region had a significantly higher positive rate of anti-HDV IgG than those in Beijing ( P =0.004), and there was no significant difference between the other regions ( P > 0.05). Clinical features of the patients with chronic HBV infection in Inner Mongolia Autonomous Region showed that compared with the anti-HDV IgG-negative group, the anti-HDV IgG-positive group had a significantly higher proportion of patients with Mongol nationality ( P =0.001), abnormal alanine aminotransferase ( P =0.007), or antiviral treatment ( P =0.029), as well as a significantly lower median HBV DNA level ( P =0.030). A total of 19 HDV RNA-positive samples were identified, all of which had HDV genotype 1. Conclusion The prevalence rate of HDV varies greatly across different regions of China, with a higher prevalence rate of HDV in patients with chronic HBV infection from Inner Mongolia Autonomous Region. HDV genotype 1 is the predominant genotype in some provinces and cities of northern China.