Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA.
Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
Clin Infect Dis. 2020 Dec 1;71(Suppl 3):S257-S265. doi: 10.1093/cid/ciaa1297.
Enteric fever, a bacterial infection caused by Salmonella enterica serotypes Typhi and Paratyphi A, frequently presents as a nonlocalizing febrile illness that is difficult to distinguish from other infectious causes of fever. Blood culture is not widely available in endemic settings and, even when available, results can take up to 5 days. We evaluated the diagnostic performance of clinical features, including both reported symptoms and clinical signs, of enteric fever among patients participating in the Surveillance for Enteric Fever in Asia Project (SEAP), a 3-year surveillance study in Bangladesh, Nepal, and Pakistan.
Outpatients presenting with ≥3 consecutive days of reported fever and inpatients with clinically suspected enteric fever from all 6 SEAP study hospitals were eligible to participate. We evaluated the diagnostic performance of select clinical features against blood culture results among outpatients using mixed-effect regression models with a random effect for study site hospital. We also compared the clinical features of S. Typhi to S. Paratyphi A among both outpatients and inpatients.
We enrolled 20 899 outpatients, of whom 2116 (10.1%) had positive blood cultures for S. Typhi and 297 (1.4%) had positive cultures for S. Paratyphi A. The sensitivity of absence of cough was the highest among all evaluated features, at 65.5% (95% confidence interval [CI], 55.0-74.7), followed by measured fever at presentation at 59.0% (95% CI, 51.6-65.9) and being unable to complete normal activities for 3 or more days at 51.0% (95% CI, 23.8-77.6). A combined case definition of 3 or more consecutive days of reported fever and 1 or more of the following (a) either the absence of cough, (b) fever at presentation, or (c) 3 or more consecutive days of being unable to conduct usual activity--yielded a sensitivity of 94.6% (95% CI, 93.4-95.5) and specificity of 13.6% (95% CI, 9.8-17.5).
Clinical features do not accurately distinguish blood culture-confirmed enteric fever from other febrile syndromes. Rapid, affordable, and accurate diagnostics are urgently needed, particularly in settings with limited or no blood culture capacity.
肠热病是由伤寒沙门氏菌血清型 Typhi 和 Paratyphi A 引起的细菌感染，常表现为难以与其他发热性传染病相区别的非定位性发热。在流行地区，血培养并不广泛应用，即使有血培养，结果也需要长达 5 天的时间。我们评估了临床特征（包括报告的症状和临床体征）在参加亚洲肠热病监测项目（SEAP）的患者中的诊断性能，该项目是在孟加拉国、尼泊尔和巴基斯坦进行的为期 3 年的监测研究。
≥3 天连续发热的门诊患者和所有 6 家 SEAP 研究医院的疑似肠热病住院患者均有资格参加。我们使用具有研究地点医院随机效应的混合效应回归模型，评估门诊患者中选择的临床特征与血培养结果的诊断性能。我们还比较了门诊和住院患者中伤寒沙门氏菌和副伤寒沙门氏菌 A 的临床特征。
我们共招募了 20899 名门诊患者，其中 2116 名（10.1%）血培养阳性为伤寒沙门氏菌，297 名（1.4%）血培养阳性为副伤寒沙门氏菌 A。所有评估特征中，无咳嗽的敏感性最高，为 65.5%（95%置信区间[CI]，55.0-74.7），其次是就诊时的测量体温，为 59.0%（95%CI，51.6-65.9），连续 3 天或以上无法完成正常活动的为 51.0%（95%CI，23.8-77.6）。连续 3 天或以上报告发热和 1 项或多项以下特征的组合诊断标准（a）无咳嗽，（b）就诊时发热，或（c）连续 3 天或以上无法进行日常活动——其敏感性为 94.6%（95%CI，93.4-95.5），特异性为 13.6%（95%CI，9.8-17.5）。
临床特征不能准确区分血培养确诊的肠热病与其他发热综合征。在血培养能力有限或缺乏的情况下，急需快速、经济、准确的诊断方法。
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