International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C.
Center for Diagnostics and Vaccine Development, Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan R.O.C.
BMC Infect Dis. 2023 Jun 1;23(1):371. doi: 10.1186/s12879-023-08346-1.
Dengue, Chikungunya, and Zika are co-endemic in Honduras and are often misdiagnosed due to similar clinical and epidemiological behavior. Most arboviral infections reported in primary care are based on clinical diagnoses without laboratory confirmation. Therefore, the accuracy of physicians' diagnoses and the factors that affect them needs to be evaluated.
A cross-sectional study with convenience sampling at primary healthcare centers was conducted from June to September 2016 and 2017. Clinical data and dried blood spots on Whatman 903 filter paper from 415 arboviral cases and 248 non-arboviral febrile cases were collected. Viral RNA was extracted from a 6-mm DBS paper disc and confirmed by RT-qPCR and sequencing.
Only 30.84% of diagnostic accuracy was observed in physicians in primary care when comparing arboviral clinical diagnosis with RT-qPCR detection. Moreover, in Dengue and Zika clinical cases, only 8.23% and 27.08% were RT-qPCR confirmed, respectively. No Chikungunya cases were confirmed. In 2017, 20.96% of febrile cases were RT-qPCR confirmed arboviral infections. The symptoms of 45.5% of arboviral cases can fit more than one case definition for arboviruses. The "symptom compliance" and "patient with suspected close contact" were the criteria most utilized by physicians for arboviral diagnosis. The pattern of the epidemiological curves of the arboviral clinical cases didn't match the one of the RT-qPCR confirmed cases.
Low diagnostic accuracy for overall and individual arboviral infections was observed in physicians. Unspecific symptomatology, overlapping case definitions, and reported close contact to an arboviral patient might contribute to misdiagnosis. Without laboratory confirmation, surveillance data may not reflect the real behavior of these diseases and could impact health interventions.
登革热、基孔肯雅热和寨卡热在洪都拉斯同时流行，由于临床和流行病学行为相似，经常被误诊。大多数在初级保健中报告的虫媒病毒感染是基于临床诊断，而没有实验室确认。因此，需要评估医生诊断的准确性及其影响因素。
2016 年 6 月至 9 月和 2017 年，在初级保健中心进行了一项横断面研究，采用便利抽样。收集了 415 例虫媒病毒病例和 248 例非虫媒病毒发热病例的临床数据和载玻片滤纸血斑。从 6mm 的 DBS 纸片上提取病毒 RNA，并用 RT-qPCR 和测序进行确认。
在将虫媒病毒的临床诊断与 RT-qPCR 检测进行比较时，初级保健医生的诊断准确率仅为 30.84%。此外，在登革热和寨卡热的临床病例中，只有 8.23%和 27.08%分别被 RT-qPCR 确认。没有确认到基孔肯雅热病例。2017 年，20.96%的发热病例被 RT-qPCR 确认为虫媒病毒感染。45.5%的虫媒病毒病例的症状符合多种虫媒病毒的病例定义。“症状符合”和“疑似与虫媒病毒患者有密切接触”是医生进行虫媒病毒诊断最常用的标准。虫媒病毒临床病例的流行病学曲线模式与 RT-qPCR 确诊病例不匹配。
医生对总体和个别虫媒病毒感染的诊断准确性较低。非特异性症状、重叠的病例定义以及报告的与虫媒病毒患者的密切接触可能导致误诊。如果没有实验室确认，监测数据可能无法反映这些疾病的真实情况，也会影响卫生干预措施。
