印度尼西亚儿童中重症新型冠状病毒肺炎多系统炎症综合征与重症登革热的对比：一项横断面研究。

Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study.

作者信息

Alam Anggraini, Andriyani Fina Meilyana, Peryoga Stanza Uga

机构信息

Infection & Tropical Diseases Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia.

Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia.

出版信息

Int J Emerg Med. 2024 Jul 11;17(1):85. doi: 10.1186/s12245-024-00658-6.

DOI:10.1186/s12245-024-00658-6

PMID:38992604

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11242006/

Abstract

INTRODUCTION

Severe multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management.

METHODS

Medical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital's PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses.

RESULTS

Seventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients.

CONCLUSION

Age, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.

摘要

引言

在登革热流行地区的新冠疫情期间，儿童严重多系统炎症综合征（MIS-C）和严重登革热难以鉴别。严重MIS-C和严重登革热均以发热、多器官受累及休克为特征。区分这两种疾病有助于开展恰当的治疗。

方法

记录2020年12月至2022年7月期间在哈桑·萨迪金综合医院儿科重症监护病房住院的18岁以下患有严重MIS-C或严重登革热的儿童的病历。采用比较分析和描述性分析评估差异。

结果

纳入17例严重登革热患者和4例严重MIS-C患者。严重MIS-C患者的平均年龄为11.5岁（标准差±2.9，95%置信区间），严重登革热患者的平均年龄为6.2岁（标准差±4.4，95%置信区间）（p值 = 0.034，95%）。发热和腹痛是两组最常见的症状（p = 0.471，95%置信区间）。皮疹（p = 0.049）和非脓性结膜炎（p = 0.035）是两种有显著差异的症状。两组之间最高血小板计数（p值 = 0.006，95%置信区间）、谷草转氨酶（p值 = 0.026，95%置信区间）和D-二聚体水平（p值 = 0.025，95%置信区间）有显著差异。所有（100%）严重MIS-C患者均发现心脏异常，而严重登革热患者中只有1例（5.9%）有心脏异常。