Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019.
Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019.
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DOI：
10.1136/bmjopen-2021-057772
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发表时间：
2021-12-24
期刊：
影响因子：
2.9
通讯作者：
Sriskandan, Shiranee
中科院分区：
文献类型：
--
作者：
Herdman, Michael Trent;Cordery, Rebecca;Karo, Basel;Purba, Amrit Kaur;Begum, Lipi;Lamagni, Theresa;Kee, Chuin;Balasegaram, Sooria;Sriskandan, Shiranee
为了应对伦敦猩红热发病率的增加和A组链球菌感染的更广泛爆发，我们的目的是了解猩红热的流行病学、症状、管理和后果，并确定与延迟诊断相关的因素。对2018-2019年伦敦三个健康保护小组通报的猩红热儿童的横断面社区研究。从2575个直接邀请的通报病例，加上410所学校/托儿所的家长网络邀请，我们收到了477份回应（占直接邀请的19%），其中412份符合病例定义。中位年龄为4岁（范围<1至16岁），48%为女性，70%为白色种族。预先计划的措施包括病例人口统计学、症状、寻求护理以及对病例和家庭的临床、社会和经济影响的定量描述。调查完成后，增加了与延迟诊断相关的因素（通过逻辑回归）和延迟诊断的后果（通过考克斯回归）的二次分析，以及自由文本评论的定性分析。89%的病例报告皮疹，但71%的病例随后出现其他症状，中位延迟1天。发病模式随年龄变化：咽喉痛在5岁及以上儿童中发病更常见（OR 3.1，95% CI 1.9 - 5.0）。在第一次咨询时，28%的人没有考虑猩红热：在这些病例中，症状通常归因于病毒感染（60%，64/106）。在出现喉咙痛的5岁以上儿童中，首次就诊后诊断延迟的情况更常见（OR 2.8 vs 5岁以上无喉咙痛的儿童; 95%CI 1.3至5.8）。延迟诊断的病例平均多花1天时间恢复基线活动。猩红热最初可能会被忽视，特别是在年龄较大的儿童出现喉咙痛。提高护理人员和从业人员的认识可能有助于识别和及时治疗。
In response to increasing incidence of scarlet fever and wider outbreaks of group A streptococcal infections in London, we aimed to characterise the epidemiology, symptoms, management and consequences of scarlet fever, and to identify factors associated with delayed diagnosis. Cross-sectional community-based study of children with scarlet fever notified to London’s three Health Protection Teams, 2018–2019. From 2575 directly invited notified cases plus invitations via parental networks at 410 schools/nurseries with notified outbreaks of confirmed/probable scarlet fever, we received 477 responses (19% of those directly invited), of which 412 met the case definition. Median age was 4 years (range <1 to 16), 48% were female, and 70% were of white ethnicity. Preplanned measures included quantitative description of case demographics, symptoms, care-seeking, and clinical, social, and economic impact on cases and households. After survey completion, secondary analyses of factors associated with delayed diagnosis (by logistic regression) and consequences of delayed diagnosis (by Cox’s regression), and qualitative analysis of free text comments were added. Rash was reported for 89% of cases, but followed onset of other symptoms for 71%, with a median 1-day delay. Pattern of onset varied with age: sore throat was more common at onset among children 5 years and older (OR3.1, 95% CI 1.9 to 5.0). At first consultation, for 28%, scarlet fever was not considered: in these cases, symptoms were frequently attributed to viral infection (60%, 64/106). Delay in diagnosis beyond first consultation occurred more frequently among children aged 5+ who presented with sore throat (OR 2.8 vs 5+without sore throat; 95% CI 1.3 to 5.8). Cases with delayed diagnosis took, on average, 1 day longer to return to baseline activities. Scarlet fever may be initially overlooked, especially among older children presenting with sore throat. Raising awareness among carers and practitioners may aid identification and timely treatment.
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影响因子：
5.9
作者：
de Lusignan, Simon;Correa, Ana;Rafi, Imran
通讯作者：
Rafi, Imran
影响因子：
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作者：
Chalker, Victoria;Jironkin, Aleksey;Underwood, Anthony
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Underwood, Anthony
影响因子：
120.7
作者：
McIsaac, WJ;Kellner, JD;Low, DE
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Low, DE
影响因子：
11.8
作者：
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通讯作者：
Van Beneden, Chris
DOI：
10.1001/jama.1993.03500030088038
发表时间：
1993-01-20
影响因子：
120.7
作者：
BREIMAN, RF;DAVIS, JP;TODD, JK
通讯作者：
TODD, JK