Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study
Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study
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DOI：
10.1371/journal.pntd.0007047
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发表时间：
2019-09-01
影响因子：
3.8
通讯作者：
Vanlerberghe, Veerle
中科院分区：
文献类型：
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作者：
Proesmans, Sam;Katshongo, Freddy;Vanlerberghe, Veerle
背景 由于当地缺乏诊断测试和广泛的鉴别诊断，在撒哈拉以南非洲地区，除疟疾外，引起急性发烧的病原体在很大程度上仍未被识别。方法 我们于 2015 年 11 月至 2016 年 6 月在刚果民主共和国金沙萨进行了一项横断面研究，包括儿童和成人门诊急性未分化热。对血液中选定的虫媒病毒感染进行了血清学和分子诊断检测，包括针对急性感染的 PCR、NS1-RDT、ELISA 和 IFA，以及针对既往感染的 ELISA 和 IFA。结果 对 342 例年龄 2 至 68 岁（平均年龄 21 岁）的急性未分化热（无明确感染灶）患者进行调查，结果显示 19 例（8.1%）由 DENV-1 和/或 DENV-2 引起的急性登革热，2 例（0.9%）急性基孔肯雅热感染。此外，分别有 30.2% 和 26.4% 的参与者过去曾感染过登革热和基孔肯雅热。我们没有发现急性寨卡病毒或黄热病病毒感染的证据。 45.3%的患者疟疾快速诊断检测呈阳性，87.7%的患者接受了抗疟治疗，64.3%的患者接受了抗菌治疗。讨论 过去曾在研究地区报告过基孔肯雅热疫情，因此高血清流行率并不令人意外。然而，关于金沙萨登革热传播的证据很少，根据我们的数据，登革热传播比之前报道的更为重要。此外，我们的研究表明，抗生素（包括抗菌药物和抗疟药物）的处方非常猖獗。像这样的研究阐明了急性发烧的原因，可能会导致更周到和更严格地使用抗生素。这不仅会遏制日益严重的抗菌素耐药性问题，而且最终有望改善资源匮乏地区门诊患者的临床护理。 作者摘要 疟疾仍然是撒哈拉以南非洲地区发烧的最重要原因之一。然而，由于多年来疟疾的诊断和治疗有了显着改善，其所占比例正在下降。因此导致出现非疟疾发热的患者数量增加。通常，没有明显的临床体征和症状，例如咳嗽或腹泻，这就探究了一个问题：“发烧的原因是什么？”先前的研究表明，撒哈拉以南非洲地区登革热和基孔肯雅热等虫媒病毒感染的负担被低估，这就是为什么我们在刚果民主共和国金沙萨郊区的一家门诊诊所对“未分化热”患者的四种常见虫媒病毒感染进行了筛查。在接受测试的患者中，我们发现十分之一的人患有急性虫媒病毒感染，几乎三分之一的患者过去曾被感染过。这些发现表明，临床医生应该更频繁地考虑虫媒病毒感染，从而避免开抗生素处方，鉴于全球抗菌素耐药性的上升，这种做法越来越成问题。
Background Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. Methodology We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections. Results Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue-caused by DENV-1 and/or DENV-2 -and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment. Discussion Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will-ultimately and hopefully-improve the clinical care of outpatients in low-resource settings.Author summary Malaria remains one of the most important causes of fever in sub-Saharan Africa. However, its share is declining, since the diagnosis and treatment of malaria have improved significantly over the years. Hence leading to an increase in the number of patients presenting with non-malarial fever. Often, obvious clinical signs and symptoms like cough or diarrhea are absent, probing the question: "What causes the fever?" Previous studies have shown that the burden of arboviral infections-like dengue and chikungunya-in sub-Saharan Africa is underestimated, which is why we screened for four common arboviral infections in patients presenting with 'undifferentiated fever' at an outpatient clinic in suburban Kinshasa, Democratic Republic of Congo. Among the patients tested, we found that one in ten presented with an acute arboviral infection and that almost one in three patients had been infected in the past. These findings suggest that clinicians should think about arboviral infections more often, thereby refraining from the prescription of antibiotics, a practice increasingly problematic given the global rise of antimicrobial resistance.