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门诊患者中的急性未分化发热性疾病:登革热、寨卡病毒病、阿根廷出血热和新型冠状病毒肺炎的鉴别诊断

[Acute undifferentiated febrile illness among outpatients: differential diagnosis between dengue, zika, Argentine hemorrhagic fever and COVID-19].

作者信息

Melcon Mario O, Garcías Celeste

机构信息

Fundación para la Investigación en Neuro Epidemiología (FINEP), Junín, Buenos Aires, Argentina. E-mail:

Fundación para la Investigación en Neuro Epidemiología (FINEP), Junín, Buenos Aires, Argentina.

出版信息

Medicina (B Aires). 2024;84(6):1215-1225.

Abstract

The "acute undifferentiated febrile illness" (AUFI) encompasses a range of diseases characterized by the presence of fever, often prompting consultations in emergency services. During epidemics like COVID-19 or dengue, a surge in consultations occurs, resulting in long wait times for patients. Errors in first diagnosis can result in severe consequences. The objective is to provide a comprehensive review of the clinical approach to AUFI, focusing on certain viral infections (dengue, zika, Argentine hemorrhagic fever and COVID-19). This involves a detailed examination of the clinical presentation, laboratory and radiological findings, neurological manifestations, and definitive diagnosis through specific serological tests. AUFI is characterized by the onset of acute fever lasting less than seven days, accompanied by myalgia or headache without involvement of the upper respiratory tract and without a defined cause. Most cases are caused by common, self-limiting viral infections (e.g., influenza); however, they may also stem from more serious viral infections with a broad etiological spectrum. The differential diagnosis of acute febrile syndromes includes various infectious diseases, such as those previously mentioned. The definitive diagnosis is based on serological methods, PCR and IgM. Recommendations based on scientific evidence can help with early diagnosis and prevent possible serious complications.

摘要

“急性未分化发热性疾病”(AUFI)涵盖一系列以发热为特征的疾病,常促使患者前往急诊就诊。在新冠疫情或登革热等流行病期间,就诊人数激增,导致患者等待时间过长。初诊错误可能会导致严重后果。目的是对AUFI的临床诊疗方法进行全面综述,重点关注某些病毒感染(登革热、寨卡病毒病、阿根廷出血热和新冠肺炎)。这包括对临床表现、实验室及影像学检查结果、神经表现以及通过特定血清学检测进行明确诊断的详细研究。AUFI的特征是急性发热持续时间少于7天,伴有肌痛或头痛,不累及上呼吸道且病因不明。大多数病例由常见的自限性病毒感染(如流感)引起;然而,它们也可能源于病因广泛的更严重病毒感染。急性发热综合征的鉴别诊断包括各种传染病,如前文所述。明确诊断基于血清学方法、聚合酶链反应(PCR)和免疫球蛋白M(IgM)。基于科学证据的建议有助于早期诊断并预防可能的严重并发症。

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