Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses
Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses
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DOI：
10.15585/mmwr.rr6801a1
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发表时间：
2019-06-14
影响因子：
33.7
通讯作者：
Waterman, Stephen H.
中科院分区：
文献类型：
--
作者：
Sharp, Tyler M.;Fischer, Marc;Waterman, Stephen H.
登革热病毒和寨卡病毒是关系密切的黄斑蚊病毒，传播周期相似，分布于热带和亚热带，疾病表现包括发烧、皮疹、肌肉痛和关节痛。对于疑似登革热或寨卡病毒疾病的患者，核酸扩增测试(NAAT)是首选的诊断方法。免疫球蛋白M(IgM)抗体检测可以识别其他感染，并仍然是诊断这些疾病的重要工具，但解释结果因交叉反应而复杂，确定感染的具体时间可能很困难。这些限制对孕妇在确定寨卡病毒感染是否发生在怀孕期间或之前是一个特别的挑战。这份报告总结了现有的和新的关于登革热和寨卡病毒诊断测试的指南，这些指南适用于居住在或最近去过有感染这两种病毒风险的地区的临床相容疾病患者。美国疾病控制与预防中心关于筛查可能接触寨卡病毒的无症状孕妇的建议没有改变。对于有症状的非孕妇，应在症状出现7天后采集血清进行登革热和寨卡病毒NAAT。对于有症状的孕妇，应在症状出现后12周内尽快收集血清和尿样，以便同时进行登革热和寨卡病毒NAAT和IgM抗体检测。当临床或流行病学显示时，应通过中和抗体试验确认阳性的IgM抗体检测结果，NAAT结果为阴性，包括所有孕妇。在决定进行哪些检测和解释结果时，应考虑已知在暴露地点传播的病毒的流行病学数据和临床结果。临床疑似登革热的患者应接受适当的治疗，以监测和治疗休克和出血。有实验室证据表明可能在怀孕期间感染寨卡病毒的妇女及其婴儿应该接受评估和管理，以确定可能的不良后果。登革热和寨卡病毒疾病是国家应通报的情况，病例应向公共卫生当局报告。
Dengue and Zika viruses are closely related mosquitoborne flaviviruses with similar transmission cycles, distribution throughout the tropics and subtropics, and disease manifestations including fever, rash, myalgia, and arthralgia. For patients with suspected dengue or Zika virus disease, nucleic acid amplification tests (NAATs) are the preferred method of diagnosis. Immunoglobulin M (IgM) antibody testing can identify additional infections and remains an important tool for the diagnosis of these diseases, but interpreting the results is complicated by cross-reactivity, and determining the specific timing of infection can be difficult. These limitations are a particular challenge for pregnant women in determining whether Zika virus infection occurred during or before the pregnancy.This report summarizes existing and new guidance on dengue and Zika virus diagnostic testing for patients with a clinically compatible illness who live in or recently traveled to an area where there is risk for infection with both viruses. CDC recommendations for screening of asymptomatic pregnant women with possible Zika virus exposure are unchanged. For symptomatic nonpregnant persons, dengue and Zika virus NAATs should be performed on serum collected 7 days after onset of symptoms. For symptomatic pregnant women, serum and urine specimens should be collected as soon as possible within 12 weeks of symptom onset for concurrent dengue and Zika virus NAATs and and IgM antibody testing. Positive IgM antibody test results with negative NAAT results should be confirmed by neutralizing antibody tests when clinically or epidemiologically indicated, including for all pregnant women. Data on the epidemiology of viruses known to be circulating at the location of exposure and clinical findings should be considered when deciding which tests to perform and for interpreting results.Patients with clinically suspected dengue should receive appropriate management to monitor and treat shock and hemorrhage. Women with laboratory evidence of possible Zika virus infection during pregnancy and their infants should be evaluated and managed for possible adverse outcomes. Dengue and Zika virus disease are nationally notifiable conditions, and cases should be reported to public health authorities.