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印度北部儿童登革热的患病率及临床鉴别

Prevalence and clinical differentiation of dengue fever in children in northern India.

作者信息

Kumar R, Tripathi P, Tripathi S, Kanodia A, Pant S, Venkatesh V

机构信息

Department of Pediatrics, King George Medical University, Lucknow, India.

出版信息

Infection. 2008 Oct;36(5):444-9. doi: 10.1007/s15010-008-7172-6. Epub 2008 Aug 30.

Abstract

STUDY

Although an increasing trend in outbreaks of dengue infection is seen in the northern Indian plains, the importance of dengue infection as a cause of acute undifferentiated febrile illness (AUFI) round the year is not known and the validity of clinical signs and simple laboratory parameters in differentiating dengue from other causes of AUFI has been sparsely reported.

OBJECTIVES

To study the prevalence of dengue infection as a cause of AUFI seen round the year and validity of clinical and simple laboratory features for its diagnosis.

METHODS

Consecutive children between 6 months and 12 years of age presenting to outpatients on 3 predecided weekdays with complaints of fever of 15 days or less duration and having no localizing signs of infection were enrolled over a 1-year period. Blood counts, liver function tests and ELISA test for dengue IgM were performed besides other investigations. Those testing positive for IgM were considered "probable dengue" (PD) while those with negative IgM tested after 5 days of illness were considered "non-dengue" (ND). Clinico-laboratory features were compared between PD and ND. A randomly selected subsample of IgM +ves was tested for dengue genome by real time PCR assay.

RESULTS

Of 298 children enrolled over 1 year, 56 (18.8%) tested positive for dengue IgM and 132 were ND. Comparing PD and ND, age, duration of illness at presentation, rash, bleeding manifestations, vomiting, platelet count, liver transaminases, serum proteins, albumen and bilirubin were significant features on univariate analysis. On logistic regression younger age, rash and higher serum alanine transaminase (sALT) levels were the only significant independent predictors for PD. Taking cutoff of age as 60 months or less and sALT > 40 units, one or more of these features were seen in 50/56 PD cases (sensitivity 89.3%). All of these were present in only 1 of 132 ND cases (specificity 99.2%). Randomly selected 44 of the 56 IgM +ve patients were subjected to PCR assay, of which 15 were positive.

CONCLUSIONS

Dengue transmission occurs round the year in this region. The cause of AUFI was definitely dengue in 15/298, i.e., 5% cases and likely to be dengue in another 13.8% cases. In children presenting to outpatients here with AUFI, young age, rash, and raised sALT are significant independent pointers to dengue. A combination of clinical and laboratory features including liver enzymes could be used to achieve high sensitivity and specificity. These results should be validated in a separate data set.

摘要

研究

尽管在印度北部平原登革热感染暴发呈上升趋势,但登革热感染作为全年急性未分化发热性疾病(AUFI)病因的重要性尚不清楚,且关于区分登革热与其他AUFI病因的临床体征和简单实验室参数的有效性报道较少。

目的

研究登革热感染作为全年AUFI病因的患病率以及其诊断的临床和简单实验室特征的有效性。

方法

在1年时间内,连续纳入6个月至12岁在3个预先确定的工作日到门诊就诊、发热持续时间为15天或更短且无感染定位体征的儿童。除其他检查外,还进行了血常规、肝功能检查和登革热IgM的酶联免疫吸附测定(ELISA)。IgM检测呈阳性者被视为“可能的登革热”(PD),而发病5天后IgM检测呈阴性者被视为“非登革热”(ND)。比较PD组和ND组的临床实验室特征。对随机选择的IgM阳性子样本进行实时聚合酶链反应(PCR)检测登革热基因组。

结果

在1年中纳入的298名儿童中,56名(18.8%)登革热IgM检测呈阳性,132名检测为ND。对PD组和ND组进行单因素分析,年龄、就诊时的病程、皮疹、出血表现、呕吐、血小板计数、肝转氨酶、血清蛋白、白蛋白和胆红素是显著特征。逻辑回归分析显示,年龄较小、皮疹和血清丙氨酸转氨酶(sALT)水平较高是PD的唯一显著独立预测因素。以年龄60个月及以下和sALT>40单位为临界值,56例PD病例中有50例(敏感性89.3%)出现这些特征中的一项或多项。132例ND病例中只有1例出现所有这些特征(特异性99.2%)。对56例IgM阳性患者中的44例进行随机选择后进行PCR检测,其中15例呈阳性。

结论

该地区全年都有登革热传播。在298例中,15例(即5%)AUFI的病因肯定是登革热,另有13.8%的病例可能是登革热。在此处因AUFI到门诊就诊的儿童中,年龄较小、皮疹和sALT升高是登革热的重要独立指标。包括肝酶在内的临床和实验室特征的组合可用于实现高敏感性和特异性。这些结果应在单独的数据集中进行验证。

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