Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019
Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019
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现代猩红热的临床管理和影响：2018-2019 年伦敦病例横断面研究的结果
DOI：
10.1101/2021.06.25.21259535
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Herdman M
中科院分区：
文献类型：
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作者：
Herdman M
为了应对伦敦猩红热发病率的增加和A组链球菌感染的更广泛爆发，我们的目的是了解猩红热的流行病学、症状、管理和后果，并确定与延迟诊断相关的因素。2018- 2019年，从2575例直接邀请的通报病例，加上通过410所学校/托儿所的家长网络发出的邀请，我们收到了477份答复（占直接邀请的19%），其中412份符合病例定义。中位年龄为4岁（范围<1 - 16岁），48%为女性，70%为白色种族。结果测量预先计划的测量包括病例人口统计学、症状、寻求护理以及对病例和家庭的临床、社会和经济影响的定量描述。调查完成后，二次分析的因素与延迟诊断（逻辑回归）和延迟诊断的后果（考克斯回归），和定性分析的自由文本comments.ResultsRash报告为89%的情况下，但随后发病的其他症状为71%，中位数1天的延迟。发病模式随年龄变化：咽喉痛在5岁及以上儿童中发病更常见（OR 3.1，95% CI 1.9 - 5.0）。在第一次咨询时，28%的人没有考虑猩红热：在这些病例中，症状通常归因于病毒感染（60%，64/106）。在出现喉咙痛的5岁以上儿童中，首次就诊后诊断延迟的情况更常见（OR 2.8 vs 5岁以上无喉咙痛的儿童; 95%CI 1.3至5.8）。延迟诊断的情况下，平均，1天以上恢复到基线activity.ConclusionsScarlet热最初可能会被忽视，特别是在年龄较大的儿童出现咽喉痛。提高护理人员和从业人员的认识可能有助于识别和及时治疗。
ObjectivesIn response to increasing incidence of scarlet fever and wider outbreaks of group A streptococcal infections in London, we aimed to characterise the epidemiology, symptoms, management and consequences of scarlet fever, and to identify factors associated with delayed diagnosis.Design and settingCross-sectional community-based study of children with scarlet fever notified to London’s three Health Protection Teams, 2018–2019.ParticipantsFrom 2575 directly invited notified cases plus invitations via parental networks at 410 schools/nurseries with notified outbreaks of confirmed/probable scarlet fever, we received 477 responses (19% of those directly invited), of which 412 met the case definition. Median age was 4 years (range <1 to 16), 48% were female, and 70% were of white ethnicity.Outcome measuresPreplanned measures included quantitative description of case demographics, symptoms, care-seeking, and clinical, social, and economic impact on cases and households. After survey completion, secondary analyses of factors associated with delayed diagnosis (by logistic regression) and consequences of delayed diagnosis (by Cox’s regression), and qualitative analysis of free text comments were added.ResultsRash was reported for 89% of cases, but followed onset of other symptoms for 71%, with a median 1-day delay. Pattern of onset varied with age: sore throat was more common at onset among children 5 years and older (OR3.1, 95% CI 1.9 to 5.0). At first consultation, for 28%, scarlet fever was not considered: in these cases, symptoms were frequently attributed to viral infection (60%, 64/106). Delay in diagnosis beyond first consultation occurred more frequently among children aged 5+ who presented with sore throat (OR 2.8 vs 5+without sore throat; 95% CI 1.3 to 5.8). Cases with delayed diagnosis took, on average, 1 day longer to return to baseline activities.ConclusionsScarlet fever may be initially overlooked, especially among older children presenting with sore throat. Raising awareness among carers and practitioners may aid identification and timely treatment.