Gourinat Ann-Claire, Cazorla Cécile, Pfannstiel Anne, Tran Thomas
Centre Hospitalier Territorial de Nouvelle-Calédonie, Microbiology Laboratory, Nouméa, New Caledonia.
Centre Hospitalier Territorial de Nouvelle-Calédonie, Infectious Diseases Department, Nouméa, New Caledonia.
JMM Case Rep. 2018 Aug 10;5(8):e005156. doi: 10.1099/jmmcr.0.005156. eCollection 2018 Aug.
Dengue fever is a major public health problem in New Caledonia, like in many Pacific Islands Countries and territories. In 2017 New Caledonia faced multiple circulations of arboviruses with a major outbreak of dengue and a co-circulating Zika virus. New Caledonia is considered as a non-endemic territory for measles since the mid 1990's.
A 41-year-old male presented fever, headache, sinusitis and exanthematous maculopapular rash. A clinical diagnosis of arbovirus was first suspected due to the local epidemic context. A few days later the patient was admitted to the main hospital. The real time RT-PCR for dengue and Zika virus were negative on the first blood sample. A drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and other infectious diseases including measles were then suspected. ELISA tests for measles were positive for IgM and equivocal for IgG. A throat swab was immediately shipped to a reference laboratory for measles nucleic acid testing. After a week, the patient recovered and the presence of measles RNA was confirmed. No secondary cases were reported among contacts of the patient and the source of his infection could not be ascertained.
Diagnosis of measles during an arbovirus outbreak in a country where measles disease is rare can be a pitfall for healthcare professionals. The introduction of measles via returned travellers or tourists from areas where measles remains endemic is a real threat to countries with high vaccine coverage.
与许多太平洋岛国和领地一样，登革热是新喀里多尼亚的一个主要公共卫生问题。2017年，新喀里多尼亚面临虫媒病毒的多重传播，登革热大爆发，同时寨卡病毒也在传播。自20世纪90年代中期以来，新喀里多尼亚被视为麻疹非流行地区。
一名41岁男性出现发热、头痛、鼻窦炎和斑丘疹皮疹。由于当地的流行情况，最初怀疑为虫媒病毒的临床诊断。几天后，患者入住主要医院。首次采集的血样中登革热和寨卡病毒的实时逆转录聚合酶链反应检测结果为阴性。随后怀疑是伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）综合征以及包括麻疹在内的其他传染病。麻疹酶联免疫吸附试验IgM呈阳性，IgG结果不明确。立即将咽拭子送往参考实验室进行麻疹核酸检测。一周后，患者康复，麻疹RNA检测结果得到确认。患者接触者中未报告二代病例，其感染源无法确定。
在麻疹罕见的国家，虫媒病毒爆发期间的麻疹诊断可能给医护人员带来困扰。通过来自麻疹仍为地方病地区的归国旅行者或游客引入麻疹，对疫苗接种率高的国家构成了真正威胁。
