Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America.
Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America.
PLoS Negl Trop Dis. 2019 Jul 22;13(7):e0007562. doi: 10.1371/journal.pntd.0007562. eCollection 2019 Jul.
Chikungunya, a mosquito-borne viral, acute febrile illness (AFI) is associated with polyarthralgia and polyarthritis. Differentiation from other AFI is difficult due to the non-specific presentation and limited availability of diagnostics. This 3-year study identified independent clinical predictors by day post-illness onset (DPO) at presentation and age-group that distinguish chikungunya cases from two groups: other AFI and dengue. Specimens collected from participants with fever ≤7 days were tested for chikungunya, dengue viruses 1-4, and 20 other pathogens. Of 8,996 participants, 18.2% had chikungunya, and 10.8% had dengue. Chikungunya cases were more likely than other groups to be older, report a chronic condition, and present <3 DPO. Regardless of timing of presentation, significant positive predictors for chikungunya versus other AFI were: joint pain, muscle, bone or back pain, skin rash, and red conjunctiva; with dengue as the comparator, red swollen joints (arthritis), joint pain, skin rash, any bleeding, and irritability were predictors. Chikungunya cases were less likely than AFI and dengue to present with thrombocytopenia, signs of poor circulation, diarrhea, headache, and cough. Among participants presenting <3 DPO, predictors for chikungunya versus other AFI included: joint pain, skin rash, and muscle, bone or back pain, and absence of thrombocytopenia, poor circulation and respiratory or gastrointestinal symptoms; when the comparator was dengue, joint pain and arthritis, and absence of thrombocytopenia, leukopenia, and nausea were early predictors. Among all groups presenting 3-5 DPO, pruritic skin became a predictor for chikungunya, joint, muscle, bone or back pain were no longer predictive, while arthritis became predictive in all age-groups. Absence of thrombocytopenia was a significant predictor regardless of DPO or comparison group. This study identified robust clinical indicators such as joint pain, skin rash and absence of thrombocytopenia that can allow early identification of and accurate differentiation between patients with chikungunya and other common causes of AFI.
基孔肯雅热是一种由蚊子传播的病毒引起的急性发热性疾病（AFI），与多关节炎和多关节炎有关。由于临床表现非特异性和诊断方法有限，与其他 AFI 很难区分。这项为期 3 年的研究通过发病后第（DPO）天的临床表现和年龄组确定了独立的临床预测因素，这些因素可将基孔肯雅热病例与两组区分开来：其他 AFI 和登革热。从发热≤7 天的参与者中采集标本，用于检测基孔肯雅热、登革热病毒 1-4 以及 20 种其他病原体。在 8996 名参与者中，18.2%患有基孔肯雅热，10.8%患有登革热。与其他组相比，基孔肯雅热病例更有可能年龄较大、报告有慢性疾病并且在<3 DPO 时出现症状。无论出现症状的时间如何，与其他 AFI 相比，基孔肯雅热的显著阳性预测因素为：关节疼痛、肌肉、骨骼或背痛、皮疹和结膜充血；与登革热相比，关节红肿（关节炎）、关节疼痛、皮疹、任何出血和烦躁不安是预测因素。与 AFI 和登革热相比，基孔肯雅热病例出现血小板减少、循环不良、腹泻、头痛和咳嗽的可能性较小。在 DPO<3 的参与者中，与其他 AFI 相比，基孔肯雅热的预测因素包括：关节疼痛、皮疹、肌肉、骨骼或背痛，以及无血小板减少、循环不良和呼吸道或胃肠道症状；当比较组为登革热时，关节疼痛和关节炎以及无血小板减少、白细胞减少和恶心是早期预测因素。在所有 DPO 为 3-5 的组中，瘙痒性皮疹成为基孔肯雅热的预测因素，关节、肌肉、骨骼或背痛不再具有预测性，而关节炎在所有年龄组中都具有预测性。无论 DPO 或比较组如何，血小板减少均为显著预测因素。本研究确定了一些强有力的临床指标，如关节疼痛、皮疹和无血小板减少症，可早期识别基孔肯雅热患者，并准确区分基孔肯雅热与其他常见 AFI 的病因。
