Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review--terra incognita impairing treatment policies.
Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review--terra incognita impairing treatment policies.
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DOI：
10.1371/journal.pone.0044269
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Bell D
中科院分区：
文献类型：
--
作者：
Acestor N;Cooksey R;Newton PN;Ménard D;Guerin PJ;Nakagawa J;Christophel E;González IJ;Bell D
越来越多地使用不包括疟疾的护理点诊断检测，加上许多疟疾流行国家的疟疾负担下降，突出表明许多卫生系统缺乏管理发热性疾病其他病因的能力。缺乏对这些病原体分布的了解，以及缺乏识别它们的筛查和护理点诊断，阻碍了对这些通常可治疗的疾病负担贡献者的有效管理。虽然前瞻性数据收集至关重要，但在已发表的卫生文献中已经存在尚未开发的知识体系。以东南亚湄公河地区为重点，对1986年至2011年发表的数据进行筛选，以确定与非疟疾发热性疾病病因学有关的病原体的分离频率。合格标准包括英语同行评审研究，记录可能需要特定管理的主要病原体。在识别的1,252篇论文中，146篇符合纳入标准，并进行了分析和数据映射。数据往往集中在研究机构开展活动的具体领域，在这些领域开展研究的资源较多。最常报告的病原体是登革热病毒（n = 70），其次是恙虫病东方体和立克次体（恙虫病/鼠斑疹伤寒/斑点热组n = 58），钩端螺旋体属。 （n = 35）、伤寒和副伤寒沙门氏菌（伤寒和副伤寒）（肠热病n = 24）、类鼻疽伯克霍尔德氏菌（类鼻疽n = 14）和日本脑炎病毒（n = 18）。 关于发热病因学的资料很少，但范围很广。这张地图显示了湄公河国家关于发热原因的信息分布非常不均匀。进一步定向收集数据，以解决证据基础的差距，并扩大到全球病原体分布数据库，是很容易实现的，并将有助于确定更广泛的研究和开发的优先事项，以改善发烧的综合征管理，优先诊断发展，并指导经验性治疗。
An increasing use of point of care diagnostic tests that exclude malaria, coupled with a declining malaria burden in many endemic countries, is highlighting the lack of ability of many health systems to manage other causes of febrile disease. A lack of knowledge of distribution of these pathogens, and a lack of screening and point-of-care diagnostics to identify them, prevents effective management of these generally treatable contributors to disease burden. While prospective data collection is vital, an untapped body of knowledge already exists in the published health literature. Focusing on the Mekong region of Southeast Asia, published data from 1986 to 2011 was screened to for frequency of isolation of pathogens implicated in aetiology of non-malarial febrile illness. Eligibility criteria included English-language peer-reviewed studies recording major pathogens for which specific management is likely to be warranted. Of 1,252 identified papers, 146 met inclusion criteria and were analyzed and data mapped. Data tended to be clustered around specific areas where research institutions operate, and where resources to conduct studies are greater. The most frequently reported pathogen was dengue virus (n = 70), followed by Orientia tsutsugamushi and Rickettsia species (scrub typhus/murine typhus/spotted fever group n = 58), Leptospira spp. (n = 35), Salmonella enterica serovar Typhi and Paratyphi (enteric fever n = 24), Burkholderia pseudomallei (melioidosis n = 14), and Japanese encephalitis virus (n = 18). Wide tracts with very little published data on aetiology of fever are apparent. This mapping demonstrates a very heterogeneous distribution of information on the causes of fever in the Mekong countries. Further directed data collection to address gaps in the evidence-base, and expansion to a global database of pathogen distribution, is readily achievable, and would help define wider priorities for research and development to improve syndromic management of fever, prioritize diagnostic development, and guide empirical therapy.
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DOI：
10.1016/j.trstmh.2008.05.014
发表时间：
2008-08-01
影响因子：
2.2
作者：
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DOI：
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期刊：
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发表时间：
2011-09-22
期刊：
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