Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan
Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan
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DOI：
10.1136/jramc-157-02-05
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发表时间：
2011-06-01
影响因子：
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通讯作者：
Green, A. D.
中科院分区：
文献类型：
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作者：
Bailey, M. S.;Trinick, T. R.;Green, A. D.
目标：自十字军东征以来，未分化的发热性疾病一直对英国远征军构成威胁。在殖民时代，世界大战和此后的较小冲突中，都发现了负责的感染，但几乎所有的感染今天仍然是一个重大威胁。自2006年以来，在阿富汗赫尔曼德省的英国军队中发生了未确诊的发热性疾病，因此进行了发热研究以确定themes.Methods：从2008年5月至10月，所有未分化的发热病例在英国战地医院在赫尔曼德省，阿富汗进行了评估，使用标准协议。结果：在6个月内，共确诊26例“赫尔曼德热”，确诊23例，其中白蛉热12例（52%），急性Q热6例（26%），立克次体感染5例（22%）。4例合并感染，7例未确诊（主要是由于样本不足）。英国野战医院的临床特征和实验室结果不允许将这些疾病彼此区分开来。立克次体感染的确切类型无法确定SPRU.Conclusions：这些情况下可能代表的“冰山一角”的英国和盟军。需要为诊断设施和病人后续行动提供更多资源，以改善对“赫尔曼德热”病例的管理和监测;在此之前，应向阿富汗赫尔曼德省所有患有未分类发热性疾病的士兵提供100毫克强力霉素，每日两次，为期两周。急性Q热患者应随访至少2年，以排除慢性Q热。预防这些疾病需要更好地了解其流行病学，但应考虑使用强力霉素和Q热疫苗进行预防。
Objectives: Undifferentiated febrile illnesses have been a threat to British expeditionary forces ever since the Crusades. The infections responsible were identified during the Colonial Era, both World Wars and smaller conflicts since, but nearly all remain a significant threat today. Undiagnosed febrile illnesses have occurred amongst British troops in Helmand, Afghanistan since 2006 and so a fever study was performed to identify them.Methods: From May to October 2008, all undifferentiated fever cases seen at the British field hospital in Helmand, Afghanistan were assessed using a standard protocol. Demographic details, clinical features and laboratory results were recorded and paired serum samples were sent for testing at the UK Special Pathogens Reference Unit (SPRU).Results: Over 6 months, there were 26 cases of "Helmand Fever" assessed and 23 diagnoses were made of which 12 (52%) were sandfly fever, 6 (26%) were acute Q fever and 5 (22%) were rickettsial infections. Four cases had co-infections and 7 cases were not diagnosed (mostly due to inadequate samples). The clinical features and laboratory results available at the British field hospital did not allow these diseases to be distinguished from each other. The exact type of rickettsial infection could not be identified at SPRU.Conclusions: These cases probably represent the "tip of an iceberg" for British and Allied forces. More resources for diagnostic facilities and follow-up of patients are required to improve the management and surveillance of "Helmand Fever" cases; until then doxycycline 100 mg twice daily for 2 weeks should be given to all troops who present with an undifferentiated febrile illness in Helmand, Afghanistan. Patients with acute Q fever should be followed-up for at least 2 years to exclude chronic Q fever. Prevention of these diseases requires a better understanding of their epidemiology, but prophylaxis with doxycycline and possibly Q fever vaccine should be considered.