Departamento de Saúde, Programa de Pós-graduação em Biomedicina Translacional, Universidade do Grande Rio, Duque de Caxias, RJ, Brazil.
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
J Clin Virol. 2020 Dec;133:104679. doi: 10.1016/j.jcv.2020.104679. Epub 2020 Oct 29.
To evaluate the accuracy of the current World Health Organization' (WHO) Chikungunya fever (CHIKF) clinical-epidemiological case definition against the gold standard of laboratory diagnosis.
This was a prospective study of patients seeking medical care at an Emergency Department in the metropolitan area of Rio de Janeiro, Brazil, from January to June 2018. Clinical features were recorded. Screening for CHIKF was performed using the RT-qPCR and ELISA-IgM antibody assay. Clinical features of CHIKF RT-qPCR/IgM positive cases were compared with those with other febrile illnesses.
27,900 ED visits were recorded, of which 172 (0.61 %) patients were screened for arboviral illness. The prevalence of laboratory-confirmed CHIKF (Lab-CHIKF) was 110/172 [64 %]. Chikungunya virus RNA was detected in 92/172 (53.5 %) patients, while in 18/80 (10.5 %), only IgM was positive. Compared to CHIKV-negative subjects, patients with CHIKF presented much earlier after the onset of symptoms (2 [1-4] vs. 3.5 [2.5-5], p = 0.007), and more frequently reported arthritis (61.8 % vs. 33.9 %, p < 0.0001), arthralgia (96.4 % vs. 79 %, p < 0.0001), and conjunctivitis (35.5 % vs. 16.1 %, p = 0.007). After adjustments for other clinical predictors, arthritis/arthralgia [aOR: 6 (95 % CI 1.8-19.7)] and the presence of conjunctivitis [aOR: 2.85 (95 % CI 1.30-6.24] were positively associated with lab-CHIKF. The sensitivity, specificity, positive predictive value, and negative predictive value of the WHO CHIKF clinical case definition was 96.3 %, 20.9 %, 68.3 % and 76.4 %, respectively, and accuracy was 0.69 [AUC: 0.69 (95 % CI 0.61-0.75)].
The WHO case definition needs to be improved for better accuracy, especially in areas in epidemics in areas with co-circulation of arboviruses.
评估世界卫生组织（WHO）基孔肯雅热（CHIKF）临床-流行病学病例定义与实验室诊断金标准的符合程度。
这是一项在巴西里约热内卢大都市区急诊室就诊的患者的前瞻性研究，时间为 2018 年 1 月至 6 月。记录临床特征。采用 RT-qPCR 和 ELISA-IgM 抗体检测对 CHIKF 进行筛查。比较 CHIKF RT-qPCR/IgM 阳性病例与其他发热性疾病的临床特征。
记录了 27900 次 ED 就诊，其中 172 例（0.61%）患者筛查了虫媒病毒病。实验室确诊的基孔肯雅热（Lab-CHIKF）患病率为 110/172[64%]。92/172（53.5%）例患者检测到基孔肯雅病毒 RNA，而 18/80（10.5%）例仅 IgM 阳性。与 CHIKV 阴性患者相比，CHIKF 患者在症状发作后更早出现（2[1-4] vs. 3.5[2.5-5]，p=0.007），更常出现关节炎（61.8% vs. 33.9%，p<0.0001）、关节痛（96.4% vs. 79%，p<0.0001）和结膜炎（35.5% vs. 16.1%，p=0.007）。在调整其他临床预测因素后，关节炎/关节痛[aOR：6（95%CI 1.8-19.7）]和结膜炎存在[aOR：2.85（95%CI 1.30-6.24]与 lab-CHIKF 呈正相关。世界卫生组织 CHIKF 临床病例定义的敏感性、特异性、阳性预测值和阴性预测值分别为 96.3%、20.9%、68.3%和 76.4%，准确性为 0.69[AUC：0.69（95%CI 0.61-0.75)]。
需要改进世界卫生组织的病例定义以提高准确性，特别是在虫媒病毒流行地区和病毒共同流行地区。
