Clinical, laboratory and virological data from suspected ZIKV patients in an endemic arbovirus area
Clinical, laboratory and virological data from suspected ZIKV patients in an endemic arbovirus area
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DOI：
10.1016/j.jcv.2017.09.002
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发表时间：
2017-11-01
影响因子：
8.8
通讯作者：
Nogueira, Mauricio Lacerda
中科院分区：
文献类型：
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作者：
Colombo, Tatiana Elias;Estofolete, Cassia Fernanda;Nogueira, Mauricio Lacerda
背景：寨卡病毒(ZIKV)的出现对临床医生和公共卫生当局都提出了新的挑战。由寨卡病毒、登革热(DENV)和基孔肯雅(CHIKV)引起的疾病之间的临床特征重叠，以及缺乏有效的寨卡病毒血清学检测，使得准确诊断变得困难。巴西当局在很大程度上依赖于临床和流行病学数据来对大多数寨卡病毒病例进行流行病学和临床分类。目的：仅根据临床和流行病学数据报告确诊的寨卡病毒患者的实验室和临床资料。研究设计：我们分析了433例由主治医生根据建议的临床标准确定的寨卡病毒疑似病例。结果：433例患者中，虫媒病毒168例(38.8%)，其中ZIKV阳性96例，DENV阳性67例(DENV-2 56例，DENV-1 9例，DENV-4 2例)，ZIKV/DENV-2混合感染4例，CHIKV阳性1例。实验室确诊的ZIKV患者最常见的体征或症状是皮疹(100%)、关节痛(77.1%)、发热(74.0%)、肌肉痛(74.0%)和非化脓性结膜炎(69.8%)。在实验室确诊的DENV感染患者中，最常见的症状是皮疹(100%)、发热(79.1%)、肌肉痛(74.6%)、头痛(73.1%)和关节痛(70.1%)。仅在腹痛(p=0.003.0 4)、白细胞减少(p=0.0 1)和血小板减少(p=0.0 1)方面，临床表现和实验室表现之间的相关性仅在腹痛(p=0.0 4)、白细胞减少(p=0.0 1)和血小板减少(p=0.0 1)方面有统计学意义。
Background: The emergence of Zika virus (ZIKV) presents new challenges to both clinicians and public health authorities. Overlapping clinical features between the diseases caused by ZIKV, dengue (DENV) and chi-kungunya (CHIKV) and the lack of validated serological assays for ZIKV make accurate diagnosis difficult. Brazilian authorities largely rely on clinical and epidemiological data for the epidemiological and clinical classifications of most ZIKV cases.Objective: : To report the laboratory and clinical profiles of patients diagnosed with Zika fever based only on clinical and epidemiological data.Study design: We analyzed 433 suspected cases of ZIKV identified by the attending physician based on proposed clinical criteria. The samples were also screened for ZIKV, DENV and CHIKV using PCR.Results: Of the 433 patients analyzed, 168 (38.8%) were laboratory-confirmed for arboviruses: 96 were positive for ZIKV, 67 were positive for DENV (56 for DENV-2, 9 for DENV-1, and 2 for DENV-4), four were positive for co-infection with ZIKV/DENV-2, and one was positive for CHIKV. The most common signs or symptoms in the patients with laboratory-confirmed ZIKV were rash (100%), arthralgia (77.1%), fever (74.0%), myalgia (74.0%) and non-purulent conjunctivitis (69.8%). In patients with laboratory-confirmed DENV infections, the most frequently observed symptoms were rash (100%), fever (79.1%), myalgia (74.6%), headache (73.1%) and arthralgia (70.1%). The measure of association between clinical manifestations and laboratory manifestations among patients with ZIKV and DENV detected a statistically significant difference only in abdominal pain (p = 0.04), leukopenia (p = 0.003), and thrombocytopenia (p = 0.01).Conclusion: Our data suggests that clinical and epidemiological criteria alone are not a good tool for ZIKV and DENV differentiation, and that laboratory diagnosis should be mandatory.