Iroh Tam Pui-Ying, Obaro Stephen K, Storch Gregory
Department of Pediatrics, University of Minnesota Medical School, Minneapolis.
Department of Pediatrics, University of Nebraska Medical Center, Omaha.
J Pediatric Infect Dis Soc. 2016 Jun;5(2):190-205. doi: 10.1093/jpids/piw016. Epub 2016 Apr 7.
Acute febrile illness is a common cause of hospital admission, and its associated infectious causes contribute to substantial morbidity and death among children worldwide, especially in low- and middle-income countries. Declining transmission of malaria in many regions, combined with the increasing use of rapid diagnostic tests for malaria, has led to the increasing recognition of leptospirosis, rickettsioses, respiratory viruses, and arboviruses as etiologic agents of fevers. However, clinical discrimination between these etiologies can be difficult. Overtreatment with antimalarial drugs is common, even in the setting of a negative test result, as is overtreatment with empiric antibacterial drugs. Viral etiologies remain underrecognized and poorly investigated. More-sensitive diagnostics have led to additional dilemmas in discriminating whether a positive test result reflects a causative pathogen. Here, we review and summarize the current epidemiology and focus particularly on children and the challenges for future research.
急性发热性疾病是住院的常见原因，其相关的感染病因在全球范围内导致儿童出现大量发病和死亡，尤其是在低收入和中等收入国家。许多地区疟疾传播的减少，加上疟疾快速诊断检测的使用增加，使得钩端螺旋体病、立克次体病、呼吸道病毒和虫媒病毒作为发热病因的认识日益增加。然而，这些病因之间的临床鉴别可能很困难。即使检测结果为阴性，抗疟药物的过度治疗也很常见，经验性抗菌药物的过度治疗也是如此。病毒病因仍然未得到充分认识且研究不足。更灵敏的诊断方法在鉴别阳性检测结果是否反映致病病原体方面带来了更多难题。在此，我们回顾并总结当前的流行病学情况，尤其关注儿童以及未来研究面临的挑战。
