Integrated fever management: disease severity markers to triage children with malaria and non-malarial febrile illness
Integrated fever management: disease severity markers to triage children with malaria and non-malarial febrile illness
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DOI：
10.1186/s12936-018-2488-x
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发表时间：
2018-10-10
期刊：
影响因子：
3
通讯作者：
Kain, Kevin C.
中科院分区：
文献类型：
--
作者：
McDonald, Chloe R.;Weckman, Andrea;Kain, Kevin C.
儿童的发热症状是全世界寻求保健行为的主要原因。大多数发热性疾病是简单的和自限性的，不需要转诊或住院。然而，目前的诊断工具无法确定哪些发热儿童患有自限性感染，哪些儿童有发展为危及生命的感染（如严重疟疾）的风险。本文介绍了需要一个简单的社区为基础的工具，可以提高发热儿童的早期识别和分流，无论是疟疾或非疟疾疾病，在危重病的风险。将疾病严重程度标记纳入现有的疟疾快速诊断测试（RDT），可以在医院和社区发现有严重感染风险的儿童，而无论病因如何。纳入疾病严重程度标志物可以为个体化管理提供信息，并对有危及生命的感染风险的儿童进行早期分诊。疟疾和疾病严重程度标志物均呈阳性的儿童可优先接受紧急转诊/入院和胃肠外治疗。疟疾阳性但疾病严重程度标志阴性的儿童可作为门诊病人进行保守治疗，给予口服抗疟疾治疗。带有疾病严重程度标记的RDT可以促进对发热综合征采取基于社区的综合方法，并改善对严重疟疾和其他危及生命的感染的早期识别、风险分层和及时治疗。
Febrile symptoms in children are a leading cause of health-care seeking behaviour worldwide. The majority of febrile illnesses are uncomplicated and self-limited, without the need for referral or hospital admission. However, current diagnostic tools are unable to identify which febrile children have self-limited infection and which children are at risk of progressing to life-threatening infections, such as severe malaria. This paper describes the need for a simple community-based tool that can improve the early recognition and triage of febrile children, with either malarial or non-malarial illness, at risk of critical illness. The integration of a disease severity marker into existing malaria rapid diagnostic tests (RDT) could enable detection of children at risk of severe infection in the hospital and community, irrespective of aetiology. Incorporation of a disease severity marker could inform individualized management and early triage of children at risk of life-threatening infection. A child positive for both malaria and a disease severity marker could be prioritized for urgent referral/admission and parenteral therapy. A child positive for malaria and negative for a disease severity marker could be managed conservatively, as an out-patient, with oral anti-malarial therapy. An RDT with a disease severity marker could facilitate an integrated community-based approach to fever syndromes and improve early recognition, risk stratification, and prompt treatment of severe malaria and other life-threatening infections.