印度急性未分化型发热：病因及诊断准确性的多中心研究

Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy.

作者信息

Mørch Kristine, Manoharan Anand, Chandy Sara, Chacko Novin, Alvarez-Uria Gerardo, Patil Suvarna, Henry Anil, Nesaraj Joel, Kuriakose Cijoy, Singh Ashita, Kurian Siby, Gill Haanshuus Christel, Langeland Nina, Blomberg Bjørn, Vasanthan Antony George, Mathai Dilip

机构信息

National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.

Department of Clinical Science, University of Bergen, Bergen, Norway.

出版信息

BMC Infect Dis. 2017 Oct 4;17(1):665. doi: 10.1186/s12879-017-2764-3.

DOI:10.1186/s12879-017-2764-3

PMID:28978319

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5628453/

Abstract

BACKGROUND

The objectives of this study were to determine the proportion of malaria, bacteraemia, scrub typhus, leptospirosis, chikungunya and dengue among hospitalized patients with acute undifferentiated fever in India, and to describe the performance of standard diagnostic methods.

METHODS

During April 2011-November 2012, 1564 patients aged ≥5 years with febrile illness for 2-14 days were consecutively included in an observational study at seven community hospitals in six states in India. Malaria microscopy, blood culture, Dengue rapid NS1 antigen and IgM Combo test, Leptospira IgM ELISA, Scrub typhus IgM ELISA and Chikungunya IgM ELISA were routinely performed at the hospitals. Second line testing, Dengue IgM capture ELISA (MAC-ELISA), Scrub typhus immunofluorescence (IFA), Leptospira Microscopic Agglutination Test (MAT), malaria PCR and malaria immunochromatographic rapid diagnostic test (RDT) Parahit Total™ were performed at the coordinating centre. Convalescence samples were not available. Case definitions were as follows: Leptospirosis: Positive ELISA and positive MAT. Scrub typhus: Positive ELISA and positive IFA. Dengue: Positive RDT and/or positive MAC-ELISA. Chikungunya: Positive ELISA. Bacteraemia: Growth in blood culture excluding those defined as contaminants. Malaria: Positive genus-specific PCR.

RESULTS

Malaria was diagnosed in 17% (268/1564) and among these 54% had P. falciparum. Dengue was diagnosed in 16% (244/1564). Bacteraemia was found in 8% (124/1564), and among these Salmonella typhi or S. paratyphi constituted 35%. Scrub typhus was diagnosed in 10%, leptospirosis in 7% and chikungunya in 6%. Fulfilling more than one case definition was common, most frequent in chikungunya where 26% (25/98) also had positive dengue test.

CONCLUSIONS

Malaria and dengue were the most common causes of fever in this study. A high overlap between case definitions probably reflects high prevalence of prior infections, cross reactivity and subclinical infections, rather than high prevalence of coinfections. Low accuracy of routine diagnostic tests should be taken into consideration when approaching the patient with acute undifferentiated fever in India.

摘要

背景

本研究的目的是确定印度急性未分化型发热住院患者中疟疾、菌血症、恙虫病、钩端螺旋体病、基孔肯雅热和登革热的比例，并描述标准诊断方法的性能。

方法

在2011年4月至2012年11月期间，印度六个邦的七家社区医院对1564名年龄≥5岁、发热2至14天的患者进行了一项观察性研究。医院常规进行疟疾显微镜检查、血培养、登革热快速NS1抗原和IgM联合检测、钩端螺旋体IgM ELISA、恙虫病IgM ELISA和基孔肯雅热IgM ELISA。二线检测，即登革热IgM捕获ELISA（MAC-ELISA）、恙虫病免疫荧光法（IFA）、钩端螺旋体显微镜凝集试验（MAT）、疟疾PCR和疟疾免疫层析快速诊断试验（RDT）Parahit Total™在协调中心进行。恢复期样本不可用。病例定义如下：钩端螺旋体病：ELISA阳性且MAT阳性。恙虫病：ELISA阳性且IFA阳性。登革热：RDT阳性和/或MAC-ELISA阳性。基孔肯雅热：ELISA阳性。菌血症：血培养有生长，但不包括那些被定义为污染物的情况。疟疾：属特异性PCR阳性。

结果

17%（268/1564）的患者被诊断为疟疾，其中54%为恶性疟原虫。16%（244/1564）的患者被诊断为登革热。8%（124/1564）的患者被发现有菌血症，其中伤寒沙门氏菌或副伤寒沙门氏菌占35%。10%的患者被诊断为恙虫病，7%为钩端螺旋体病，6%为基孔肯雅热。符合多个病例定义的情况很常见，在基孔肯雅热中最为频繁，其中26%（25/98）的患者登革热检测也呈阳性。