Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia
Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia
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DOI：
10.1016/j.trstmh.2004.09.012
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发表时间：
2005-06-01
影响因子：
2.2
通讯作者：
van Dissel, JT
中科院分区：
文献类型：
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作者：
Vollaard, AM;Ali, S;van Dissel, JT
在印度尼西亚雅加达，超过80%的伤寒或副伤寒患者在门诊接受治疗。在一项以社区为基础的前瞻性被动监测研究中，我们确定了59例伤寒、23例副伤寒和259例非肠道发热门诊患者，所有患者均经血培养证实。我们比较了他们的症状，目的是制定一个临床预测规则，可能有助于指导经验性抗生素治疗疑似（帕拉）伤寒病例，而不是所有发热患者，或转诊患者进行额外的诊断测试。副伤寒（甲型副伤寒沙门氏菌）在临床上不能与伤寒区分。对疑似（帕拉）伤寒患者进行经验性抗生素治疗和卫生措施建议的决定应考虑到发烧第一周的寒战和无咳嗽以及疾病第二周的谵妄。这种预测规则增加了伤寒的可能性，从第一周的1：10增加到第二周的2：3。然而，我们无法提出一个强大的临床预测规则，可用于作为绝对筛选方法的决定，额外的诊断测试，因为（帕拉）伤寒的表现症状的敏感性低。(c)2005年皇家热带医学和卫生学会。由爱思唯尔有限公司出版。保留所有权利。
In Jakarta, Indonesia, over 80% of patients with typhoid fever or paratyphoid fever are treated in outpatient settings. In a community-based prospective passive surveillance study, we identified 59 typhoid, 23 paratyphoid fever and 259 non-enteric fever outpatients, all blood culture-confirmed. We compared their symptoms with the aim of developing a clinical prediction rule that may help direct empirical antibiotic treatment to cases with suspected (para)typhoid fever, rather than all febrile patients, or refer patients for additional diagnostic tests. Paratyphoid fever (Salmonella paratyphi A) could not be distinguished clinically from typhoid fever. Decisions on empirical antibiotic treatment and advice on hygiene measures in patients with suspected (para)typhoid fever should take into account chills and absence of cough in the first week of fever and delirium in the second week of illness. This prediction rule increases the likelihood of (para)typhoid fever from 1:10 in the first week to, at most, 2:3 in the second week of a febrile illness. However, we were not able to propose a robust clinical prediction rule that could be used as absolute screening method for decisions on additional diagnostic tests, because of the low sensitivity of presenting symptoms in (para)typhoid fever. (c) 2005 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.