Unité de maladie infectieuse et tropicale, centre hospitalier Andrée Rosemon, Cayenne, 97300 Guyane française, France; Département de médecine générale, université des Antilles, 97157 Pointe-à-Pitre, France.
Unité de maladie infectieuse et tropicale, centre hospitalier Andrée Rosemon, Cayenne, 97300 Guyane française, France.
Med Mal Infect. 2019 Jun;49(4):250-256. doi: 10.1016/j.medmal.2018.09.010. Epub 2018 Oct 19.
Chikungunya (CHIKV) and dengue viruses (DENV) are two arboviruses with epidemic potential and similar clinical presentations. The potential life-threatening risk associated with DENV justifies an immediate biological assessment and medical follow-up which may be delayed for CHIKV.
To compare the clinical variables that would help differentiate patients infected with CHIKV or DENV, and then to compute a predictive score.
Retrospective case-control study comparing CHIKV-infected patients diagnosed by RT-PCR in 2014 with patients infected with DENV diagnosed by positive NS1 antigen test in 2013. Children aged<15 years and pregnant women were excluded. Clinical and biological variables were compared, and a multivariate analysis was performed. A clinical score was developed using the β coefficients to differentiate the infections.
Over the study period 168 patients infected with CHIKV were compared with 452 patients with DENV. The clinical variables independently associated with CHIKV was joint and back pain, and those associated with DENV were headache, muscle pain, nausea/vomiting, diarrhea, and hemorrhagic signs. The clinical score had 98% sensitivity for DENV and a ROC curve of 0.96.
These two infections have a similar clinical presentation but the use of the proposed clinical score during the acute phase of the disease would make it possible to identify cases of DENV during a CHIKV epidemic to suggest adequate patient management.
基孔肯雅热（CHIKV）和登革热病毒（DENV）是两种具有流行潜力和相似临床表现的虫媒病毒。DENV 可能带来危及生命的风险，因此需要立即进行生物评估和医学随访，而 CHIKV 感染则可能需要延迟评估。
比较有助于区分 CHIKV 或 DENV 感染患者的临床变量，并计算预测评分。
这是一项回顾性病例对照研究，比较了 2014 年通过 RT-PCR 诊断为 CHIKV 感染的患者与 2013 年通过 NS1 抗原检测阳性诊断为 DENV 感染的患者。排除了年龄<15 岁的儿童和孕妇。比较了临床和生物学变量，并进行了多变量分析。使用β系数开发了一种临床评分，用于区分感染。
在研究期间，共比较了 168 例 CHIKV 感染患者和 452 例 DENV 感染患者。与 CHIKV 感染相关的独立临床变量是关节和腰背疼痛，与 DENV 感染相关的独立临床变量是头痛、肌肉疼痛、恶心/呕吐、腹泻和出血迹象。该临床评分对 DENV 的敏感性为 98%，ROC 曲线为 0.96。
这两种感染具有相似的临床表现，但在疾病的急性阶段使用提出的临床评分可以在 CHIKV 流行期间识别出 DENV 病例，从而为患者提供适当的管理建议。
