登革热——诊断、风险分层与治疗

Dengue Fever—Diagnosis, Risk Stratification, and Treatment.

作者信息

Witte Paul, Venturini Stefan, Meyer Helene, Zeller Andreas, Christ Michael

机构信息

Multidisciplinary Emergency Center, Cantonal Hospital of Lucerne, Lucerne, Switzerland; General Internal Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland; University Center for Primary Care Medicine Basel, University of Basel, Basel, Switzerland.

出版信息

Dtsch Arztebl Int. 2024 Nov 15;121(23):773-778. doi: 10.3238/arztebl.m2024.0175.

Abstract

BACKGROUND

Dengue fever is a common infectious disease in the tropical and subtropical zones, with more than 100 million symptomatic cases per year. Mosquitoes of the genus Aedes (Aedes aegypti, Aedes albopticus) are vectors of the disease, and their spread has led to rising case numbers around the world. Physicians in Europe, too, are increasingly being confronted by this challenge.

METHODS

This review is based on the findings of a selective search in international publication databases, as well as on the WHO guideline of 2009 and the current recommendations of the Robert Koch Institute.

RESULTS

Dengue fever takes a mild course in more than 90% of cases. Severe dengue fever, up to and including shock and/or mucosal hemorrhages, is rare and carries a mortality of 1-5%. The disease characteristically takes a triphasic course (febrile phase, critical phase, recovery phase). It is diagnosed by the direct demonstration of the pathogen (e.g., with the reverse transcriptase polymerase chain reaction [RT-PCR] up to day 5 of the illness) or by serology. Patients are classified into one of three risk groups depending on their findings and comorbidities and are then treated either as outpatients or in the hospital. The treatment is symptomatic, as no treatment directed against the cause of the disease is available. The key measures are adequate volume replacement and, in patients with hemorrhage, the transfusion of blood products. Preventive steps include vaccination after a documented initial infection and the meticulous avoidance of mosquito bites.

CONCLUSION

Climate change and global mobility have led to a worldwide increase in dengue fever. The disease only rarely takes a severe course. In such cases, rapid symptomatic treatment as needed is the key to the avoidance of severe complications.

摘要

背景

登革热是热带和亚热带地区的一种常见传染病,每年有超过1亿例有症状的病例。伊蚊属(埃及伊蚊、白纹伊蚊)的蚊子是该疾病的传播媒介,它们的传播导致全球病例数不断上升。欧洲的医生也越来越多地面临这一挑战。

方法

本综述基于在国际出版物数据库中的选择性检索结果,以及世界卫生组织2009年的指南和罗伯特·科赫研究所的当前建议。

结果

超过90%的登革热病例病程较轻。严重登革热,直至包括休克和/或黏膜出血,较为罕见,死亡率为1% - 5%。该疾病典型地呈三相病程(发热期、关键期、恢复期)。通过直接检测病原体(例如,在发病第5天之前用逆转录酶聚合酶链反应[RT-PCR])或血清学进行诊断。根据患者的检查结果和合并症将其分为三个风险组之一,然后作为门诊患者或住院患者进行治疗。治疗为对症治疗,因为没有针对病因的治疗方法。关键措施是充分的容量替代,对于出血患者,输注血液制品。预防措施包括在首次感染确诊后进行疫苗接种以及精心避免蚊虫叮咬。

结论

气候变化和全球流动性导致登革热在全球范围内增加。该疾病很少会发展为重症。在这种情况下,根据需要进行快速对症治疗是避免严重并发症的关键。

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