Management of adolescents and adults with febrile illness in resource limited areas.
Management of adolescents and adults with febrile illness in resource limited areas.
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DOI：
10.1136/bmj.d4847
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发表时间：
2011-08-08
期刊：
影响因子：
--
通讯作者：
Parry CM
中科院分区：
文献类型：
--
作者：
Crump JA;Gove S;Parry CM
在低收入国家，发烧在寻求医疗保健的青少年和成年人中很常见；在这种情况下，病死率往往很高，潜在的传染性和非传染性原因范围很广（表1）。这些差异，加上资源有限，意味着为高收入国家制定的管理准则不能轻易适用于资源有限的地区。由于一系列疾病具有相似的临床特征，因此仅凭临床病史和体格检查往往难以作出诊断。诊断问题可能由于实验室诊断测试能力有限而复杂化。可用的实验室服务可能有限或没有；实验室服务对用户来说可能过于昂贵；可能存在对结果质量的关注；对于一些在当地很重要的感染，可能还没有开发出实用可靠的诊断测试。当临床和实验室评估不能确定发烧的具体原因时，医疗保健提供者可以根据患者表现出的临床特征的“综合征”进行经验性治疗，通常由推荐基于综合征的治疗方法的管理指南指导。世界卫生组织已经为低收入国家的初级卫生保健提供者和地区医院临床医生制定了一系列婴儿和儿童临床综合症管理算法。45 2004年出版了针对青少年和成人的类似指南，并于2009年更新，适用于一级卫生设施的初级卫生保健提供者。6 .正在编写指导地区医院临床医生的世卫组织手册。理想情况下，指南应经过验证，适应当地条件，并根据当地或全国现有的监测结果或哨点医院研究结果加以改进。我们回顾了低收入地区青少年和成人发热性疾病的管理方法，我们将其定义为在过去48小时内有发热史，感觉发热或腋窝温度为37.5℃或更高。聚焦
Fever is common among adolescents and adults seeking healthcare in low income countries; in this setting, case fatality rates are often high and the range of potential infectious and non-infectious causes is broad (table 1). 1 2 These differences, combined with limited resources, mean that management guidelines developed for high income countries cannot readily be adapted to resource limited areas. It is often difficult to establish a diagnosis from the clinical history and physical examination alone because a range of diseases share similar clinical features. The diagnostic problem may be compounded by limited laboratory capacity for diagnostic testing. 3 There may be limited or no laboratory services available; laboratory services may be prohibitively expensive for users; concerns may exist regarding the quality of results; and practical reliable diagnostic tests may not have been developed for some infections of local importance. When clinical and laboratory evaluations do not identify a specific cause for fever, healthcare providers may treat empirically according to the “syndrome” of clinical features that the patient presents with, often guided by management guidelines that recommend approaches to treatment based on syndromes. World Health Organization algorithms for the management of infants and children with a range of clinical syndromes have been developed for primary healthcare providers and district hospital clinicians in low income countries. 4 5 Similar guidelines for adolescents and adults were published in 2004 and updated in 2009 for primary healthcare providers at first level health facilities. 6 A WHO manual to guide district hospital clinicians is in development. Ideally, guidelines should be validated, adapted to local conditions, and improved on the basis of the results of locally or nationally available surveillance or sentinel hospital studies.We review the approach to the management of adolescents and adults with febrile illness—which we define as having a history of fever in the past 48 hours, feeling hot, or having an axillary temperature of 37.5 ºC or more—in low income areas. Focusing
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影响因子：
15.8
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
10.1016/j.trstmh.2004.01.011
发表时间：
2004-11-01
影响因子：
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作者：
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56.3
作者：
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DOI：
10.1016/s0035-9203(03)90070-8
发表时间：
2003-07-01
影响因子：
2.2
作者：
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通讯作者：
Gilks, CF