Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America.
PLoS Negl Trop Dis. 2021 Feb 16;15(2):e0009133. doi: 10.1371/journal.pntd.0009133. eCollection 2021 Feb.
Our purpose was to provide a detailed clinical description, of symptoms and laboratory abnormalities, and temporality in patients with confirmed Zika and dengue infections, and other acute illnesses of unidentified origin (AIUO).
METHODS/ PRINCIPAL FINDINGS: This was a two-year, multicenter, observational, prospective, cohort study. We collected data from patients meeting the Pan American Health Organization's modified case-definition criteria for probable Zika infection. We identified Zika, dengue chikungunya by RT-PCR in serum and urine. We compared characteristics between patients with confirmed Zika and dengue infections, Zika and AIUO, and Dengue and AIUO at baseline, Days 3,7,28 and 180 of follow-up. Most episodes (67%) consistent with the PAHO definition of probable Zika could not be confirmed as due to any flavivirus and classified as Acute Illnesses of Unidentified Origin (AIUO). Infections by Zika and dengue accounted for 8.4% and 16% of episodes. Dengue patients presented with fever, generalized non-macular rash, arthralgia, and petechiae more frequently than patients with Zika during the first 10 days of symptoms. Dengue patients presented with more laboratory abnormalities (lower neutrophils, lymphocytosis, thrombocytopenia and abnormal liver function tests), with thrombocytopenia lasting for 28 days. Zika patients had conjunctivitis, photophobia and localized macular rash more frequently than others. Few differences persisted longer than 10 days after symptoms initiation: conjunctivitis in Zika infections, and self-reported rash and petechia in dengue infections.
Our study helps characterize the variety and duration of clinical features in patients with Zika, dengue and AIUO. The lack of diagnosis in most patients points to need for better diagnostics to assist clinicians in making specific etiologic diagnoses.
本研究旨在详细描述确诊的 Zika 与登革热感染患者以及其他急性病因不明疾病（AIUO）患者的症状和实验室异常情况及其时间变化。
方法/主要发现：这是一项为期两年、多中心、观察性、前瞻性队列研究。我们收集了符合泛美卫生组织（PAHO）修改后的疑似 Zika 感染病例定义标准的患者数据。通过 RT-PCR 检测血清和尿液中的 Zika、登革热和基孔肯雅病毒。我们比较了确诊 Zika 与登革热感染、Zika 与 AIUO、登革热与 AIUO 患者的基线、第 3、7、28 和 180 天的特征。符合 PAHO 疑似 Zika 定义的大多数（67%）病例无法通过任何黄病毒感染得到证实，被归类为急性病因不明疾病（AIUO）。Zika 和登革热感染分别占病例的 8.4%和 16%。在症状出现的前 10 天，登革热患者比 Zika 患者更常出现发热、全身性非斑疹性皮疹、关节痛和瘀点。登革热患者更常出现实验室异常（中性粒细胞减少、淋巴细胞增多、血小板减少和肝功能异常），血小板减少可持续 28 天。Zika 患者比其他患者更常出现结膜炎、畏光和局部斑疹。在症状出现 10 天后仍持续存在的差异很少：Zika 感染患者的结膜炎，以及登革热感染患者自述的皮疹和瘀点。
本研究有助于描述 Zika、登革热和 AIUO 患者的临床表现种类和持续时间。大多数患者未得到明确诊断，这表明需要更好的诊断方法来帮助临床医生做出特定病因诊断。
