登革热是越南急性未分化型发热的一个病因。
Dengue as a cause of acute undifferentiated fever in Vietnam.
作者信息
Phuong Hoang Lan, de Vries Peter J, Nga Tran T T, Giao Phan T, Hung Le Q, Binh Tran Q, Nam Nguyen V, Nagelkerke Nico, Kager Piet A
机构信息
Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands.
出版信息
BMC Infect Dis. 2006 Jul 25;6:123. doi: 10.1186/1471-2334-6-123.
BACKGROUND
Dengue is a common cause of fever in the tropics but its contribution to the total burden of febrile illnesses that is presented to primary health facilities in endemic regions such as Vietnam, is largely unknown. We aimed to report the frequency of dengue as a cause of fever in Binh Thuan Province, to describe the characteristics of dengue patients, and analyze the diagnostic accuracy of the health care workers and the determinants of the diagnostic process.
METHODS
All patients presenting with acute undifferentiated fever at twelve community health posts and one clinic at the provincial malaria station, Binh Thuan Province, a dengue endemic province in southern Vietnam, were included. Record forms were used to fill in patient and diseases characteristics, pre-referral treatment, signs and symptoms, provisional diagnosis and prescribed treatment, referral and final outcome. Serum samples were collected at first presentation and after 3 weeks for serologic diagnosis.
RESULTS
2096 patients were included from April 2001 to March 2002. All 697 patients with paired serum samples were tested for dengue virus IgM and IgG. Acute dengue was found in 33.6% cases and past dengue virus infections were found in 57.1% cases. Acute primary infections were more common among children under 15 years old than among adults (7.7% vs. 3.5%, p value < 0.001). Younger age significantly predicted acute dengue (RR per increasing year of age (95 % CI): 0.986 (0.975-0.997, p value = 0.014). 48.9% of cases with clinical diagnosis of acute dengue were serologically confirmed and 32.5% of cases without clinical diagnosis of acute dengue were positive by serology after all (OR = 1.981, p value 0.025, 95% CI: 1.079-3.635). Tourniquet test was not a predictor for dengue diagnosis.
CONCLUSION
Dengue is responsible for one third of the fevers presented to the public primary health services in Binh Thuan, southern Vietnam. It presents as a highly unspecific illness and is hardly recognized as a clinical entity by primary physicians.
背景
登革热是热带地区发热的常见病因，但在越南等流行地区，其在基层医疗卫生机构发热疾病总负担中所占的比例很大程度上尚不清楚。我们旨在报告越南平顺省登革热作为发热病因的频率，描述登革热患者的特征，并分析医护人员的诊断准确性以及诊断过程的决定因素。
方法
纳入了越南南部登革热流行省份平顺省12个社区卫生站和省级疟疾防治站的1个诊所中所有出现急性未分化发热的患者。使用记录表格填写患者和疾病特征、转诊前治疗、体征和症状、初步诊断和规定治疗、转诊及最终结果。在首次就诊时和3周后采集血清样本进行血清学诊断。
结果
2001年4月至2002年3月期间共纳入2096例患者。对所有697例有配对血清样本的患者进行了登革病毒IgM和IgG检测。33.6%的病例为急性登革热，57.1%的病例有既往登革病毒感染。15岁以下儿童的急性原发性感染比成人更常见（7.7%对3.5%，p值<0.001）。年龄越小，急性登革热的预测可能性越大（年龄每增加一岁的相对危险度（95%可信区间）：0.986（0.975 - 0.997，p值 = 0.014）。临床诊断为急性登革热的病例中，48.9%经血清学确诊，而所有病例中，32.5%临床未诊断为急性登革热的病例血清学呈阳性（比值比 = 1.981，p值0.025，95%可信区间：1.079 - 3.635）。束臂试验不是登革热诊断的预测指标。
结论
在越南南部平顺省，登革热占基层公共卫生服务机构所接诊发热病例的三分之一。它表现为一种高度非特异性疾病，基层医生很难将其识别为一种临床实体。
Zotero 插件