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与其他儿童急性发热综合征相比,登革热是否被高估了?

Is there an overestimation of dengue compared with that of other acute febrile syndromes in childhood?

机构信息

University of Fortaleza (UNIFOR), Graduate Program in Medical Sciences, Fortaleza, Ceará, Brazil.

Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil.

出版信息

PLoS Negl Trop Dis. 2024 Jun 7;18(6):e0012137. doi: 10.1371/journal.pntd.0012137. eCollection 2024 Jun.

Abstract

A group of children with clinical suspicion of dengue were assessed to determine if there was an overestimation of dengue compared with that of leptospirosis and leishmaniasis. This descriptive and analytical cross-sectional study, based on the active search of participants with acute febrile illness, was conducted at two pediatric hospitals. The collection of clinical and epidemiological data was performed using questionnaires, and laboratory tests specific for dengue were performed using immunochromatographic, serological, and molecular methods. Dengue-negative samples were assessed for Leptospira and Leishmania spp. using molecular tests. Data were assessed using analysis of variance (ANOVA), the chi-square test, and Fisher's exact test. In total, 86 participants were evaluated, of whom 39 (45%) were positive for dengue fever, 4 (5%) for leptospirosis, and 1 (1%) for leishmaniasis. Forty-two participants (49%) presented dengue-like symptoms. The predominant age range for the virus was 3-10 years. Most clinical manifestations were nonspecific, with frequent concomitant gastrointestinal and respiratory symptoms. Furthermore, we found that the acute febrile syndrome in childhood persists as a challenge for health professionals, especially in the early days of the disease, due to a plurality of diagnostic hypotheses, associated with the difficulty of establishing well-defined symptoms in children, especially in infants. Dengue fever continues to be a frequent pathology with acute febrile infections in childhood; however, there is an overestimation of the disease, especially in endemic regions, when one considers only the clinical epidemiological diagnosis.

摘要

一组有临床疑似登革热的儿童接受了评估,以确定与钩端螺旋体病和利什曼病相比,登革热的诊断是否存在高估。这项描述性和分析性的横断面研究基于对急性发热疾病患者的主动搜索,在两家儿科医院进行。使用问卷收集临床和流行病学数据,并使用免疫层析法、血清学和分子方法进行针对登革热的实验室检测。对登革热阴性样本使用分子检测进行钩端螺旋体和利什曼原虫属的检测。使用方差分析(ANOVA)、卡方检验和 Fisher 精确检验评估数据。共评估了 86 名参与者,其中 39 名(45%)为登革热阳性,4 名(5%)为钩端螺旋体病阳性,1 名(1%)为利什曼病阳性。42 名(49%)参与者出现登革热样症状。病毒的主要年龄范围为 3-10 岁。大多数临床表现是非特异性的,常伴有胃肠道和呼吸道症状。此外,我们发现,由于多种诊断假设,再加上儿童症状难以明确界定,尤其是婴儿,急性发热综合征在儿童中仍持续存在,对卫生专业人员构成挑战,尤其是在疾病的早期阶段。登革热仍是儿童急性发热感染的常见疾病;然而,在流行地区,仅考虑临床流行病学诊断,疾病的诊断可能存在高估。

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