Juillien Gaëlle, Haroche Julien, Bonnet Pascale, Rozenberg Flore, Riou Bruno, Hausfater Pierre
Service d'Accueil des Urgences, Centre Hospitalier Universitaire, Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
J Med Virol. 2007 Jul;79(7):935-8. doi: 10.1002/jmv.20921.
In febrile patients, distinguishing bacterial from viral infections is crucial for early treatment initiation and rational use of antibiotics. Raised interferon-alpha (IFN-alpha) levels in serum has been associated with a wide range of viral infections. We evaluated the effectiveness of IFN-alpha serum measurements for the etiological diagnosis of febrile patients. Adult patients who were attending the emergency department with body temperature above or equal to 38.5 degrees C were studied prospectively, followed-up until day 30, and classified by two independent experts (blind for IFN-alpha results) as having a bacterial/parasitic infection, viral infection, or other diagnosis. The results of IFN-alpha measurements in blood samples taken in the emergency room, were compared with expert diagnosis. Among 243 patients included, 167 had bacterial/parasitic infections (including 19 with viral co-infection), 59 had viral infections, and 36 other diagnoses. IFN-alpha assay had a sensitivity of 0.44 and a specificity of 0.92 for the diagnosis of viral infection. Among the 20 patients with acute viral infection according to the emergency physician diagnosis, 7 (35%) were given antibiotics, including four patients with raised IFN-alpha concentrations. It is concluded that in febrile patients, raised serum IFN-alpha level is highly specific of the viral etiology of fever but poorly sensitive. Reliable viral and bacterial biological markers are needed in order to improve rational use of antibiotics.
在发热患者中，区分细菌感染和病毒感染对于尽早开始治疗及合理使用抗生素至关重要。血清中干扰素-α（IFN-α）水平升高与多种病毒感染有关。我们评估了检测血清IFN-α水平对发热患者进行病因诊断的有效性。对到急诊科就诊、体温高于或等于38.5摄氏度的成年患者进行前瞻性研究，随访至第30天，并由两名独立专家（对IFN-α检测结果不知情）分类为患有细菌/寄生虫感染、病毒感染或其他诊断。将在急诊室采集的血样中IFN-α检测结果与专家诊断结果进行比较。在纳入的243例患者中，167例患有细菌/寄生虫感染（包括19例合并病毒感染），59例患有病毒感染，36例为其他诊断。IFN-α检测对病毒感染诊断的敏感性为0.44，特异性为0.92。在急诊医生诊断为急性病毒感染的20例患者中，7例（35%）使用了抗生素，其中4例IFN-α浓度升高。结论是，在发热患者中，血清IFN-α水平升高对发热的病毒病因具有高度特异性，但敏感性较差。为了改善抗生素的合理使用，需要可靠的病毒和细菌生物学标志物。
