Herten Pieter-Jan, Vlieghe Erika, Bottieau Emmanuel, Florence Eric, Jorens Philippe G
General Hospital Voorkempen/Emmaus group, Malle B-2390, Belgium.
Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital (UZA), University of Antwerp, Edegem B-2650, Belgium.
J Transl Int Med. 2022 Nov 23;10(4):328-339. doi: 10.2478/jtim-2022-0042. eCollection 2022 Dec.
Several tropical or geographically confined infectious diseases may lead to organ failure requiring management in an intensive care unit (ICU), both in endemic low- and middle-income countries where ICU facilities are increasingly being developed and in (nonendemic) high-income countries through an increase in international travel and migration. The ICU physician must know which of these diseases may be encountered and how to recognize, differentiate, and treat them. The four historically most prevalent "tropical" diseases (malaria, enteric fever, dengue, and rickettsiosis) can present with single or multiple organ failure in a very similar manner, which makes differentiation based solely on clinical signs very difficult. Specific but frequently subtle symptoms should be considered and related to the travel history of the patient, the geographic distribution of these diseases, and the incubation period. In the future, ICU physicians may also be more frequently confronted with rare but frequently lethal diseases, such as Ebola and other viral hemorrhagic fevers, leptospirosis, and yellow fever. No one could have foreseen the worldwide 2019-up to now coronavirus disease 2019 (COVID-19) crisis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was initially spread by travel too. In addition, the actual pandemic due to SARS-CoV-2 reminds us of the actual and potential threat of (re)-emerging pathogens. If left untreated or when treated with a delay, many travel-related diseases remain an important cause of morbidity and even mortality, even when high-quality critical care is provided. Awareness and a high index of suspicion of these diseases is a key skill for the ICU physicians of today and tomorrow to develop.
几种热带或地域局限的传染病可能导致器官衰竭，需要在重症监护病房（ICU）进行治疗。无论是在地方病流行的低收入和中等收入国家（这些国家的ICU设施正在不断发展），还是在（非地方病流行的）高收入国家（由于国际旅行和移民增加），情况都是如此。ICU医生必须了解可能遇到哪些此类疾病，以及如何识别、区分和治疗它们。历史上最常见的四种“热带”疾病（疟疾、伤寒、登革热和立克次体病）可能以非常相似的方式出现单器官或多器官衰竭，这使得仅根据临床症状进行区分非常困难。应考虑特定但往往不明显的症状，并将其与患者的旅行史、这些疾病的地理分布以及潜伏期联系起来。未来，ICU医生可能还会更频繁地面对罕见但往往致命的疾病，如埃博拉和其他病毒性出血热、钩端螺旋体病和黄热病。没有人能够预见由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发的2019年至今的全球冠状病毒病2019（COVID-19）危机，该病最初也是通过旅行传播的。此外，由SARS-CoV-2引发的实际大流行提醒我们（再）出现的病原体的实际和潜在威胁。如果不进行治疗或治疗延迟，即使提供了高质量的重症护理，许多与旅行相关的疾病仍然是发病甚至死亡的重要原因。对这些疾病的认识和高度怀疑指数是当今和未来ICU医生需要培养的关键技能。
