Richens J, Smith T, Mylius T, Spooner V
Goroka Base Hospital, Papua New Guinea.
P N G Med J. 1992 Dec;35(4):298-302.
The objective of this study was to determine which clinical features of typhoid and malaria are most helpful in distinguishing the two diseases among Papua New Guinean highlanders. In a study of 35 patients with culture-positive typhoid and 49 with blood-slide-positive malaria (Group 1), the odds of typhoid were increased most in patients with altered bowel habit, an illness of more than 2 week's duration, tremor or the presence of typhoid facies. The odds of typhoid were lowest in patients with pallor or jaundice. These findings were used to derive a clinical diagnostic algorithm, which was then evaluated in a further group of 34 typhoid patients and 41 malaria patients (Group 2). The sensitivity of the algorithm in diagnosing malaria was 91% in Group 1 and 71% in Group 2, with specificities of 85% and 79% respectively. For typhoid, the sensitivity of the algorithm was 85% and 79% for Groups 1 and 2, respectively, and the specificities were 91% and 71%. We conclude that the algorithm merits further evaluation in a primary health care setting and may prove useful in making an earlier diagnosis of typhoid.
本研究的目的是确定伤寒和疟疾的哪些临床特征最有助于在巴布亚新几内亚高地人中区分这两种疾病。在一项对35例血培养确诊伤寒患者和49例血涂片确诊疟疾患者的研究（第1组）中，肠道习惯改变、病程超过2周、震颤或出现伤寒面容的患者患伤寒的几率增加最多。面色苍白或黄疸的患者患伤寒的几率最低。这些发现被用于推导一种临床诊断算法，然后在另外一组34例伤寒患者和41例疟疾患者中（第2组）进行评估。该算法诊断疟疾的敏感性在第1组中为91%，在第2组中为71%，特异性分别为85%和79%。对于伤寒，该算法在第1组和第2组中的敏感性分别为85%和79%，特异性分别为91%和71%。我们得出结论，该算法值得在初级卫生保健环境中进一步评估，可能有助于更早地诊断伤寒。
