Institute for Clinical Medicine, University of Aarhus, Denmark and Department of Infectious Diseases, The Royal Hospital, Muscat, Oman.
Clinical and Research Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy.
Clin Microbiol Infect. 2018 Apr;24(4):369-375. doi: 10.1016/j.cmi.2017.10.035. Epub 2017 Nov 15.
This paper review trends in emerging infections and the need for increased clinical and laboratory surveillance.
Factors that contributed to the emergence of recent outbreaks have been reviewed. Known, major outbreaks over the past two decades were reviewed.
We identified at least four major drivers of emergent infections: (i) increasing density of the human population; (ii) stress from farmland expansion on the environment; (iii) globalization of the food market and manufacturing; (iv) environmental contamination. The factors creating new opportunities for emerging infections include: (i) population growth; (ii) spread in health care facilities; (iii) an ageing population; (iv) international travel; (v) changing and expanding vector habitats.
Emerging infections are unpredictable. In this review we argue that to discover new trends in infectious diseases, the clinicians have to look for the unusual and unexpected and ensure proper diagnostics and that syndromic surveillance must be supported by highly specialized laboratory services. Mathematical modeling has not been able to predict outbreaks More emphasis on the biology of evolution is needed. EID rarely stands out as unusual, and the continuous pressure on health care budgets forces clinicians and laboratories to prioritize their diagnostic work-up to common and treatable conditions. The European Society for Infectious Diseases and Clinical Microbiology, ESCMID, has established an Emerging Infections Task Force, EITaF, to strengthen the activities of the society on emerging infections and ensure that emerging infections is included in differential diagnostic considerations in everyday clinical practice.
本文回顾了新发感染的趋势,并强调了加强临床和实验室监测的必要性。
回顾了促成近期暴发的因素。同时还回顾了过去二十年来已知的重大暴发。
我们确定了至少四个引发新发感染的主要驱动因素:(i)人口密度的增加;(ii)农田扩张对环境造成的压力;(iii)食品市场和制造业的全球化;(iv)环境污染。为新发感染创造新机会的因素包括:(i)人口增长;(ii)医疗机构的传播;(iii)人口老龄化;(iv)国际旅行;(v)病媒栖息地的变化和扩大。
新发感染是不可预测的。在本次综述中,我们认为,要发现传染病的新趋势,临床医生必须寻找不寻常和意外的情况,并确保进行适当的诊断。此外,综合征监测必须得到高度专业化的实验室服务的支持。数学模型尚未能够预测暴发。需要更加重视进化生物学。EID 很少显得异常,而且医疗保健预算的持续压力迫使临床医生和实验室将其诊断工作重点放在常见且可治疗的病症上。欧洲临床微生物学和传染病学会(ESCMID)已成立新发感染特别工作组(EITaF),以加强学会在新发感染方面的活动,并确保新发感染在日常临床实践中的鉴别诊断中得到考虑。