Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
J Microbiol Immunol Infect. 2017 Feb;50(1):104-111. doi: 10.1016/j.jmii.2014.12.001. Epub 2014 Dec 26.
Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors.
We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals.
Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase > aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9 mg/L, absence of bone pain, and absence of a bleeding syndrome.
Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment.
登革热、立克次体病和 Q 热是热带地区具有相似表现的急性发热性疾病。通过了解有区别的临床特征以及人口统计学和气象因素的意义，可以早期将丛林斑疹伤寒、鼠型斑疹伤寒和 Q 热从登革热中鉴别出来。
我们进行了一项回顾性研究，以确定三家台湾医院的 454 例登革热、178 例丛林斑疹伤寒、143 例 Q 热和 81 例鼠型斑疹伤寒病例的临床、人口统计学和气象特征。
鼠型斑疹伤寒和 Q 热的病例数与温度和降雨量显著相关；丛林斑疹伤寒病例数仅与温度显著相关。登革热病例数与温度或降雨量均无相关性。台湾 1 月至 6 月登革热病例罕见，这可能是该地区诊断的一个有用线索。观察到男性优势，男性与女性的比例为鼠型斑疹伤寒的 2.1，Q 热的 7.4。多变量分析显示，有六个重要因素可将立克次体病和 Q 热组与登革热组区分开来：发热≥8 天、丙氨酸氨基转移酶＞天冬氨酸氨基转移酶、血小板＞63,000/mL、C 反应蛋白＞31.9 mg/L、无骨痛和无出血综合征。
了解台湾上半年登革热的罕见性和这六个鉴别因素可能有助于促进立克次体病和 Q 热从登革热中的早期鉴别诊断，从而进行早期抗生素治疗。
