Challenges of Establishing the Correct Diagnosis of Outbreaks of Acute Febrile Illnesses in Africa: The Case of a Likely Brucella Outbreak among Nomadic Pastoralists, Northeast Kenya, March-July 2005
Challenges of Establishing the Correct Diagnosis of Outbreaks of Acute Febrile Illnesses in Africa: The Case of a Likely Brucella Outbreak among Nomadic Pastoralists, Northeast Kenya, March-July 2005
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DOI：
10.4269/ajtmh.2011.11-0030
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发表时间：
2011-11-01
影响因子：
3.3
通讯作者：
Feikin, Daniel R.
中科院分区：
文献类型：
--
作者：
Ari, Mary D.;Guracha, Argata;Feikin, Daniel R.
据报告，在肯尼亚东北部偏远干旱地区的索马里牧民中爆发了急性发热性疾病，在那里饮用生牛奶是很常见的。对12名患者的血液标本进行了病毒、细菌和寄生虫病原体检测，这些标本大多是在恢复期后期采集的。病毒和伤寒血清学均为阴性。9例患者在至少一项检测中发现布鲁氏菌抗体，其中4例通过参考血清学显微凝集试验有提示急性感染的证据。免疫球蛋白M酶联免疫吸附试验3例钩端螺旋体抗体阳性，2例疟疾阳性。尽管敏感和特定的护理点检测方法将改善发展中国家对急性发热性疾病的诊断，但当疫情发生在偏远地区、标本采集过晚以及对多种疾病获得阳性结果时，解释的挑战仍然存在。在这种情况下，需要更好的诊断和工具来解读重叠的体征和症状。
An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.