Waggoner Jesse, Brichard Julie, Mutuku Francis, Ndenga Bryson, Heath Claire Jane, Mohamed-Hadley Alisha, Sahoo Malaya K, Vulule John, Lefterova Martina, Banaei Niaz, Mukoko Dunstan, Pinsky Benjamin A, LaBeaud A Desiree
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.
Department of Pediatrics, Division of Infectious Diseases.
Open Forum Infect Dis. 2017 May 29;4(3):ofx110. doi: 10.1093/ofid/ofx110. eCollection 2017 Summer.
In sub-Saharan Africa, malaria is frequently overdiagnosed as the cause of an undifferentiated febrile illness, whereas arboviral illnesses are presumed to be underdiagnosed.
Sera from 385 febrile Kenyan children, who presented to 1 of 4 clinical sites, were tested using microscopy and real-time molecular assays for dengue virus (DENV), chikungunya virus (CHIKV), malaria, and .
Malaria was the primary clinical diagnosis for 254 patients, and an arboviral infection (DENV or CHIKV) was the primary diagnosis for 93 patients. In total, 158 patients (41.0%) had malaria and 32 patients (8.3%) had CHIKV infections. Compared with real-time polymerase chain reaction, microscopy demonstrated a percent positive agreement of 49.7%. The percentage of malaria cases detected by microscopy varied significantly between clinical sites. Arboviral infections were the clinical diagnosis for patients on the Indian Ocean coast (91 of 238, 38.2%) significantly more often than patients in the Lake Victoria region (2 of 145, 1.4%; < .001). However, detection of CHIKV infections was significantly higher in the Lake Victoria region (19 of 145 [13.1%] vs 13 of 239 [5.4%]; = .012).
The clinical diagnosis of patients with an acute febrile illness, even when aided by microscopy, remains inaccurate in malaria-endemic areas, contributing to inappropriate management decisions.
在撒哈拉以南非洲地区，疟疾常被过度诊断为未分化发热性疾病的病因，而虫媒病毒疾病则被认为诊断不足。
对前往4个临床地点之一就诊的385名肯尼亚发热儿童的血清进行检测，采用显微镜检查和实时分子检测法检测登革热病毒（DENV）、基孔肯雅病毒（CHIKV）、疟疾等。
254例患者的主要临床诊断为疟疾，93例患者的主要诊断为虫媒病毒感染（DENV或CHIKV）。共有158例患者（41.0%）患有疟疾，32例患者（8.3%）患有CHIKV感染。与实时聚合酶链反应相比，显微镜检查显示阳性符合率为49.7%。显微镜检查检测到的疟疾病例百分比在各临床地点之间存在显著差异。在印度洋沿岸地区，虫媒病毒感染是患者的临床诊断（238例中的91例，38.2%），明显多于维多利亚湖地区的患者（145例中的2例，1.4%；P< .001）。然而，维多利亚湖地区CHIKV感染的检测率明显更高（145例中的19例[13.1%]对239例中的13例[5.4%]；P = .012）。
在疟疾流行地区，即使借助显微镜检查，急性发热性疾病患者的临床诊断仍然不准确，这导致了不恰当的管理决策。
