a Aix Marseille University, IRD, AP-HM, SSA, VITROME , Marseille , France.
b IHU-Méditerranée Infection , Marseille , France.
Emerg Microbes Infect. 2019;8(1):339-352. doi: 10.1080/22221751.2019.1580539.
Acute undifferentiated fever (AUF) is frequently observed in tropical settings, but diagnosing the cause of AUF is often a challenge for local physicians and the physicians treating returning travellers. We conducted a case-control study in central Vietnam in 2016. A total of 378 febrile adult patients (AUFs) with a fever for ≤21 days, no evidence of localized infection and negative screening tests for dengue and malaria, and 384 afebrile adult patients (Controls) were prospectively enrolled. Whole blood, plasma, eschar swab, throat swab and urine specimens were collected and analysed. Quantitative PCR and RT-PCR were used to test for 55 bacteria, viruses and their subtypes. Serological tests were also used to test for rickettsial agents. The most common aetiology was influenza virus (20.9% in AUFs vs. 0% in Controls), followed by rickettsial agents (mainly Orientia tsutsugamushi and Rickettsia typhi) (10.8% vs. 0.3%), dengue virus (7.7% vs. 0.5%), Leptospira (4.8% vs. 0.8%), adenovirus (4.8% vs. 1.0%), and enterovirus (2.1% vs. 0%) (p < .05). The real proportion of dengue in AUF cases was underestimated because patients with dengue-positive rapid diagnosis tests were excluded from the study. The emerging agent Rickettsia felis, which had not been previously observed in Vietnam, was detected in this study. In total, 216 patients (57.1%) were given causative diagnoses, comprising 143 (66.2%) monoinfections and 73 (33.8%) coinfections. The infections caused by these agents should be considered in clinical practice and further studies. Additionally, agents susceptible to doxycycline were detected in 15.6% of AUFs; thus, this drug should be included in the panel used to treat AUF patients.
急性不明原因发热（AUF）在热带地区很常见，但当地医生和治疗归国旅行者的医生通常难以确定 AUF 的病因。我们在 2016 年于越南北部中部进行了一项病例对照研究。共前瞻性纳入 378 例发热≤21 天的成年 AUF 患者（AUFs）、无局部感染证据且登革热和疟疾筛查试验阴性以及 384 例不发热的成年对照患者。采集全血、血浆、焦痂拭子、咽拭子和尿液标本进行分析。采用定量 PCR 和 RT-PCR 检测 55 种细菌、病毒及其亚型。还进行血清学检测以检测立克次体病原体。最常见的病因是流感病毒（AUFs 中为 20.9%，对照组中为 0%），其次是立克次体病原体（主要为恙虫病东方体和伤寒杆菌）（AUFs 中为 10.8%，对照组中为 0.3%）、登革热病毒（AUFs 中为 7.7%，对照组中为 0.5%）、钩端螺旋体（AUFs 中为 4.8%，对照组中为 0.8%）、腺病毒（AUFs 中为 4.8%，对照组中为 1.0%）和肠道病毒（AUFs 中为 2.1%，对照组中为 0%）（p<0.05）。由于排除了登革热快速诊断检测阳性的患者，因此低估了 AUF 病例中登革热的实际比例。本研究中还检测到了以前在越南未观察到的新发立克次体病原体费氏立克次体。共有 216 例（57.1%）患者被明确诊断出病因，包括 143 例（66.2%）单一感染和 73 例（33.8%）混合感染。在临床实践中应考虑这些病原体引起的感染，并开展进一步研究。此外，AUFs 中还检测到 15.6%的药物敏感病原体，因此，在治疗 AUF 患者时应将此类药物纳入治疗方案。
