Jezek Z, Szczeniowski M, Paluku K M, Mutombo M, Grab B
Communicable Diseases Division, World Health Organization, Geneva, Switzerland.
Acta Trop. 1988 Dec;45(4):297-307.
Human monkeypox is a zoonosis occurring sporadically in the tropical rain forest of western and central Africa. The exact incidence and geographical distribution are unknown, since many cases are not recognized. Special surveillance was established in three regions in Zaire in 1981 that led to a substantial increase in reported cases. The question arose as to the possibility that clinical diagnostic errors cause some cases of monkeypox to be misdiagnosed as other eruptive diseases. This paper presents the results of a study assessing the extent of and reasons for these clinical diagnostic errors in areas where health staff as well as the general public are aware of human monkeypox. In Zaire in the period 1981-1986, 977 persons with skin eruption not clinically diagnosed as human monkeypox were laboratory tested. 3.3% of human monkeypox cases were found among 730 patients diagnosed as cases of chickenpox, 7.3% among cases diagnosed as "atypical chickenpox" and 6.1% among cases with skin rash for which clinical diagnosis could not be established. The diagnostic difficulties were mainly based on clinical features characteristic of chickenpox: regional pleomorphism (in 46% of misdiagnosed cases), indefinite body-distribution of skin eruptions (49%), and centripetal distribution of skin lesions (17%). Lymph-node enlargement was observed in 76% of misdiagnosed patients. In the absence of smallpox, the main clinical diagnostic problem is the differentiation of human monkeypox from chickenpox. The presence of lymphadenopathy, pre-eruptive fever and slower maturation of skin lesions are the most important clinical signs supporting correct diagnosis of monkeypox.
人类猴痘是一种在非洲西部和中部热带雨林中偶尔出现的人畜共患病。由于许多病例未被识别，确切的发病率和地理分布尚不清楚。1981年在扎伊尔的三个地区建立了专门监测，这使得报告病例大幅增加。于是出现了一个问题，即临床诊断错误是否可能导致一些猴痘病例被误诊为其他出疹性疾病。本文介绍了一项研究的结果，该研究评估了在卫生工作人员和普通公众都知晓人类猴痘的地区，这些临床诊断错误的程度和原因。在1981 - 1986年期间的扎伊尔，对977名临床上未被诊断为人类猴痘的皮疹患者进行了实验室检测。在730名被诊断为水痘的患者中发现了3.3%的人类猴痘病例，在被诊断为“非典型水痘”的病例中发现了7.3%，在临床无法确诊皮疹的病例中发现了6.1%。诊断困难主要基于水痘的临床特征：局部多形性（在46%的误诊病例中）、皮疹在身体上分布不明确（49%）以及皮肤病变向心性分布（17%）。在76%的误诊患者中观察到淋巴结肿大。在没有天花的情况下，主要的临床诊断问题是将人类猴痘与水痘区分开来。淋巴结病、出疹前发热以及皮肤病变成熟较慢是支持正确诊断猴痘的最重要临床体征。
