National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Int J Infect Dis. 2020 Sep;98:241-249. doi: 10.1016/j.ijid.2020.06.071. Epub 2020 Jun 25.
Dengue and Zika infections cause illnesses with overlapping clinical manifestations. The aim of this study was to explore the association of each of these infections with single or grouped clinical and laboratory parameters.
Clinical and laboratory data were collected prospectively from a cohort of patients seeking care for symptoms meeting the Pan American Health Organization's modified case-definition criteria for probable Zika virus infection. Zika and dengue were diagnosed with RT-PCR. The relationship of clinical characteristics and laboratory data with Zika, dengue, and undefined acute illness (UAI) was examined.
In the univariate models, localized rash and maculopapular exanthema were associated with Zika infection. Generalized rash, petechiae, and petechial purpuric rash were associated with dengue. Cough and confusion/disorientation were associated with UAI. Platelets were significantly lower in the dengue group. A conditional inference tree model showed poor sensitivity and positive predictive value for individual viral diagnoses.
Clusters of signs, symptoms, and laboratory values evaluated in this study could not consistently differentiate Zika or dengue cases from UAI in the clinical setting at the individual patient level. We identified symptoms that are important to Zika and dengue in the univariate analyses, but predictive models were unreliable. Low platelet count was a distinctive feature of dengue.
登革热和寨卡病毒感染可引起临床表现重叠的疾病。本研究旨在探讨这两种感染与单一或分组的临床和实验室参数之间的关联。
前瞻性地从一组因疑似寨卡病毒感染而符合泛美卫生组织修正病例定义标准的症状前来就诊的患者中收集临床和实验室数据。采用 RT-PCR 诊断寨卡病毒和登革热。研究了临床特征和实验室数据与寨卡病毒、登革热和未明急性病（UAI）之间的关系。
在单变量模型中，局部皮疹和斑丘疹与寨卡病毒感染有关。全身性皮疹、瘀点和瘀斑性紫癜性皮疹与登革热有关。咳嗽和意识混乱/定向障碍与 UAI 有关。血小板在登革热组中显著降低。条件推理树模型显示，在个体患者水平上，对个体病毒诊断的敏感性和阳性预测值均较差。
本研究评估的体征、症状和实验室值簇在临床环境中不能始终如一地将寨卡病毒或登革热病例与 UAI 区分开来。我们在单变量分析中确定了与寨卡病毒和登革热有关的重要症状，但预测模型不可靠。血小板计数低是登革热的一个显著特征。
