Clinical features and dynamic ordinary laboratory tests differentiating dengue fever from other febrile illnesses in children
Clinical features and dynamic ordinary laboratory tests differentiating dengue fever from other febrile illnesses in children
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DOI：
10.1016/j.jmii.2016.08.018
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发表时间：
2018-10-01
影响因子：
7.4
通讯作者：
Li, Chung-Chen
中科院分区：
文献类型：
--
作者：
Chen, Chih-Ho;Huang, Yi-Chuan;Li, Chung-Chen
背景：登革热在出现经典症状之前不易诊断。本研究旨在探讨儿科患者的临床特征和动态实验室检查，以促进登革热的诊断。方法：回顾性分析2014年6月至12月所有临床疑似登革热患儿的医疗记录。通过检测非结构蛋白NS1、登革热病毒逆转录聚合酶链反应和登革热特异性IgM血清转化，确诊实验室阳性登革热病例。结果：317例小儿临床疑似登革热病例中，实验室阳性205例，实验室阴性112例。在实验室阳性病例中，156例（76.1%）以皮疹为主要临床表现。白细胞减少发生在第1-5天；血小板减少，第2-7天；延长活化部分凝血活素时间（aPTT），在第1-4天；第3-11天转氨酶水平升高；和低CRP，在第0-14天。皮疹、瘙痒、瘀点合并的特异性和阳性预测值（PPV）提高至100%。白细胞减少、血小板减少和转氨酶升高合并的PPV在第2天和第6-8天达到100%。结论：白细胞减少、血小板减少、aPTT升高、转氨酶升高、CRP降低可作为登革热与其他发热性疾病的鉴别指标。在登革热流行期间，结合症状和实验室结果有助于医生准确诊断登革热。版权所有：台湾省微生物学会由爱思唯尔台湾有限责任公司发布。这是一篇基于CC by - nc - nd许可的开放获取文章。
Background: Dengue fever is not easily to be diagnosed before presentation of the classic symptoms. The study aimed to investigate the clinical features and dynamic laboratory tests in pediatric patients to facilitate dengue diagnosis.Methods: This retrospective study examined the medical records of all pediatric patients who were clinically suspected to have dengue from June to December 2014. Laboratory-positive dengue cases were confirmed by detecting non-structural protein NS1, reverse transcription-polymerase chain reaction of dengue virus, and dengue-specific IgM seroconversion.Results: Of the 317 pediatric cases clinically suspected of dengue, 205 were laboratory-positive and 112 were laboratory-negative. In laboratory-positive cases, the most common clinical manifestation was skin rash in 156 (76.1%). Leukopenia occurred on days 1-5; thrombocytopenia, on days 2-7; prolonged activated partial thromboplastin time (aPTT), on days 1-4; and elevated transaminase levels, on days 3-11; and low CRP, on days 0-14. The specificity and positive predictive value (PPV) of combining of rash, itching and petechiae increased up to 100%. The PPV of combining of leukopenia, thrombocytopenia, and elevated transaminase levels reached 100% on day 2 as well as days 6-8.Conclusion: Leukopenia, thrombocytopenia, elevated aPTT, elevated transaminase levels, and low CRP could be used to differentiate dengue fever from other febrile illnesses. During dengue epidemics, combinations of the symptoms and laboratory findings are helpful to physicians for accurate diagnosis of dengue fever. Copyright (C) 2017, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license.