我国登革热病例临床特征研究进展

登革热是由登革病毒感染引起经蚊虫叮咬传播的一种虫媒病毒性疾病。广泛流行于全球热带和亚热带地区,人对登革病毒普遍易感,登革热临床症状、体征主要包括高热、全身肌肉关节痛、皮疹等,实验室生化检查指标主要有白细胞和血小板减少等。登革热重症病例救治不及时,死亡率较高,早期临床诊断登革热病例对于降低患者死亡率和防止登革热疫情暴发或扩散具有重要价值。登革热临床病例特征主要包括症状、体征和实验室生化检查,本文就登革热上述临床特征研究进展进行综述。     

三氮唑核苷治疗登革热

登革热是由登革病毒引起、经蚊传播的急性传染病 ,以发热 ,皮疹 ,肌肉骨关节剧烈疼痛 ,淋巴结肿大 ,白细胞减少等为主要表现。治疗采用综合治疗和对症处理。近年有部分报道使用抗病毒药治疗 ,能缩短本病病程。 2 0 0 0年 6月至 10月 ,本院共收治登革热患者 14 4例 ,对其中部分患者使用抗病毒药三氮唑核苷治疗 ,观察病程恢复情况 ,现报道如下。资料与方法一、病例选择及分组全部患者均为该年度流行区内、流行季节本院住院患者。患者具有典型临床症状、体征和化验相应诊断指标 ,全部患者临床分型均为典型登革热 ,无出血型、休克型、脑型。全体…     

成人斯蒂尔病104例临床和疗效分析

目的 探讨成人斯蒂尔病(AOSD)的临床特点、实验室检查结果及疗效.方法 回顾性分析104例AOSD患者的临床资料,总结临床特征、药物治疗方法和疗效.结果 临床表现:高热100%,皮疹95%,关节痛和(或)关节炎90%,咽痛78%,淋巴结肿大66%,脾脏肿大57%,浆膜炎30%;实验室检查中,中性粒细胞增多98%,肝功能异常62%,红细胞沉降率增快96%,血清铁蛋白升高99%.淋巴结活检者100%为反应性增生.94%应用糖皮质激素,66%患者联合应用了免疫抑制剂;激素用量≥140 mg/d者平均缓解时间缩短,复发率低.结论 不明原因的高热患者,合并皮疹、关节痛,血白细胞和炎症指标升高,排除感染和肿瘤后应考虑AOSD.糖皮质激素和免疫抑制剂是治疗AOSD的最有效药物.     

成人Still病24例临床特征分析

<正>成人Still病(AOSD)是以高热、关节痛、皮疹以及外周血白细胞升高为主要表现的全身性疾病,其病因及发病机制尚未完全明了。AOSD临床表现复杂,无特异性诊断方法,故临床上误诊率较高。以往普遍认为AOSD预后良好,但近年来我院收治的AOSD合并急性肝脏功能衰竭、噬血细胞综合征、急性呼吸窘迫综合征等重症病例亦不在少数。2014—2015年我院收治了24例AOSD患者,其中4例合     

登革热并发病毒性心肌炎13例分析

目的了解登革热并发病毒性心肌炎的临床特点。方法对2006年8-11月我院收治的390例登革热患者中出现病毒性心肌炎13例患者的资料进行回顾性分析。结果13例登革病毒性心肌炎患者中男8例,女5例,各年龄段均有发生;6例出现胸闷和（或）心悸等症状,另外7例患者未出现心肌炎症状;心电图改变多样化,以心动过缓及ST段改变为主;CK、CK—MB、AST、LDH早期有升高;13例患者血小板均有降低,其中有6例低于5．0×10^9／L,1例出现消化道出血,2例痰中带血,11例有出血性皮疹;予营养心肌及对症支持治疗后病情得到明显改善。结论登革热并发病毒性心肌炎发病隐匿,症状较轻,病程多为自限性,预后良好,易漏诊,须要早期行动态心电图观察,动态心肌酶学变化也有助于诊断。     

登革热病例持续发生

登革热(DF，又称骨折热，Dandy热及其它的名称)是由黄病毒属中4种病毒中的任何一种引起，该病毒为登革热病毒1-4型。登革热是一种持续时间短、非致命的疾病，以突然发作的头痛、后眼眶痛、高热、关节痛和皮疹为特点。普通的DF有时会更隐秘。根据已知免疫增强机制，某种登革热病毒的持续感染会导致更严重的并发症、登革出血热(DHF)和登革休克综合征。所以不复杂的DF能够预示DHF的存在。     

2020年广西岑溪市308例登革热患者临床特征分析

目的 分析广西岑溪市地区308例登革热患者的流行病学特征、临床表现、治疗及预后情况,为登革热的防治提供参考.方法 收集2020年9月1日—10月31日在岑溪市人民医院确诊的308例登革热患者临床信息,根据年龄,将308例患者分为老年组(≥60岁)与非老年组(<60岁),收集患者人口学资料、流行病学资料、临床表现、实验室及影像学检查结果、治疗及预后情况,分析比较2组患者的流行病学特点.结果 登革热患者以中青年人群为主,主要临床症状包括发热、纳差、皮疹、肌肉酸痛、瘙痒.非老年组患者的皮疹、瘙痒症状发生率分别为81.51％、49.81％,均显著高于老年组(P均<0.05).老年组与非老年组病原学检测结果阳性率比较差异均无统计学意义(P均>0.05).老年组PLT及ALB降低的发生率分别为32.56％和81.40％,明显高于非老年组(P均<0.05),2组患者的其他血液指标异常率比较差异均无统计学意义(P均>0.05).25例患者胸部CT或胸片有不同程度异常改变.结论 本次登革热暴发流行首起病例的传染源尚不明,发病人群以中青年为主,发热、纳差、皮疹、肌肉酸痛、瘙痒为其主要临床症状,目前对登革热的发病机制尚未完全明确,临床上尚无疫苗可有效预防登革热,预防登革热以切断传染源为主,而早诊断、早隔离、早治疗为治疗本病的关键举措.     

2020年广西岑溪市308例登革热患者临床特征分析

目的 分析广西岑溪市地区308例登革热患者的流行病学特征、临床表现、治疗及预后情况,为登革热的防治提供参考.方法 收集2020年9月1日—10月31日在岑溪市人民医院确诊的308例登革热患者临床信息,根据年龄,将308例患者分为老年组(≥60岁)与非老年组(<60岁),收集患者人口学资料、流行病学资料、临床表现、实验室及影像学检查结果、治疗及预后情况,分析比较2组患者的流行病学特点.结果 登革热患者以中青年人群为主,主要临床症状包括发热、纳差、皮疹、肌肉酸痛、瘙痒.非老年组患者的皮疹、瘙痒症状发生率分别为81.51％、49.81％,均显著高于老年组(P均<0.05).老年组与非老年组病原学检测结果阳性率比较差异均无统计学意义(P均>0.05).老年组PLT及ALB降低的发生率分别为32.56％和81.40％,明显高于非老年组(P均<0.05),2组患者的其他血液指标异常率比较差异均无统计学意义(P均>0.05).25例患者胸部CT或胸片有不同程度异常改变.结论 本次登革热暴发流行首起病例的传染源尚不明,发病人群以中青年为主,发热、纳差、皮疹、肌肉酸痛、瘙痒为其主要临床症状,目前对登革热的发病机制尚未完全明确,临床上尚无疫苗可有效预防登革热,预防登革热以切断传染源为主,而早诊断、早隔离、早治疗为治疗本病的关键举措.     

70例登革热并发肝损伤患者临床特征和预后因素分析*

目的 总结登革热(DF)并发肝损伤的临床特点。方法 2019年1～12月广东省第二人民医院收治的70例DF患者,给予DF患者对症处理,给予肝损伤患者甘草酸类护肝、降酶和对症处理。总结分析临床资料,包括血液和血生化指标。结果 在70例DF患者中,主要症状有发热、关节痛、皮疹、腹痛、腹泻、呼吸道和泌尿道感染,外周血白细胞降低者34例,血小板计数降低者35例,血生化异常33例;33例肝功能损伤患者住院时间为(7.1±2.2)天,显著长于37例无肝损伤患者【(5.8±2.0),P<0.05】,70例DF患者经治疗后均治愈出院,无死亡病例;肝损伤与无肝损伤患者外周血白细胞计数无显著性差异(P>0.05),但肝损伤患者血小板计数为(105.0±48.6)×10⁹/L,显著低于无肝损伤组【(156.2±88.7)×10⁹/L,P<0.05】;肝损伤组血生化指标主要表现为血清ALT、AST、GGT、CRP和CK-MB水平轻度升高,但均恢复良好。结论 DF患者可能并发肝损伤,但总体肝损伤程度轻,护肝降酶效果好,恢复快。     

成人Still病32例临床分析

目的探讨成人Still病的临床特点,提高诊断的正确率。方法回顾分析32例成人Still病的临床表现及化验检查,分析其临床特点。结果高热（体温≥39．0℃）、一过性皮疹、关节痛、白细胞、中性粒细胞增高（白细胞≥12．0×10^9／L,中性粒细胞≥80％）、血清铁蛋白增高,血沉、C-反应蛋白增高,肝脾淋巴结肿大是多见的表现,非甾体类抗炎药加糖皮质激素或／和免疫抑制剂是常用的治疗方法。结论成人Still病临床表现及实验室检查缺乏特异性,诊断时应符合参考诊断标准并除外其他疾病。     

Secondary dengue virus type 4 infections in Vietnam

This study was designated to describe clinical and biological features of patients with a suspected diagnosis of dengue fever/dengue hemorrhagic fever during an outbreak in Central Vietnam. One hundred and twenty-five consecutive patients hospitalized at Khanh Hoa and Binh Thuan Provincial hospitals between November 2001 and January 2002 with a diagnosis of suspected dengue infection were included in the present study.Viruses were isolated in C6/36 and VERO E6 cell cultures or detected by RT-PCR. A hemagglutination-inhibition test (HI) was done on each paired sera using dengue antigens type 1-4, Japanese encephalitis (JE) virus antigen, Chickungunya virus antigen and Sindbis virus antigen. Anti-dengue and anti-JE virus IgM were measured by a capture enzyme-linked immunosorbent assay (MAC-ELISA). Anti-dengue and anti-JE virus IgG were measured by an ELISA test. Dengue viruses were isolated in cell culture and/or detected by RT-PCR in 20.8% of blood samples. DEN-4 and DEN-2 serotypes were found in 18.4% and 2.4% of the patients, respectively. A total of 86.4% of individuals had a diagnosis of acute dengue fever by using the HI test and/or dengue virus-specific IgM capture-ELISA and/or virus isolation and/or RT-PCR. The prevalence of primary and secondary acute dengue infection was 4% and 78.4%, respectively. Anti-dengue IgG ELISA test was positive in 88.8% of the patients. In 5 cases (4%), Japanese encephalitis virus infection was positive by serology but the cell culture was negative. No Chickungunya virus or Sindbis virus infection was detected by the HI test. In patients with acute dengue virus infection, the most common presenting symptom was headache, followed by conjunctivitis, petechial rash, muscle and joint pain, nausea and abdominal pain. Four percent of hospitalized patients were classified as dengue hemorrhagic fever. The clinical presentation and blood cell counts were similar between patients hospitalized with acute dengue fever and patients with other febrile illnesses.     

Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2–7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs.     

Dengue fever: diagnostic importance of a camelback fever pattern

We present a case of imported dengue fever in a 52-year-old man acquired during a recent trip to Ecuador. Fever in a returning traveler from tropical areas often presents a diagnostic problem for clinicians. Our patient presented with severe arthralgias and myalgias and had a camelback/saddleback fever pattern accompanied by relative bradycardia, which was a clue to the diagnosis. He had conjunctival suffusion and the truncal rash, but adenopathy was not present. He also had a generalized headache and abdominal pain. Nonspecific laboratory abnormalities included leukopenia, lymphopenia, atypical lymphocytes, thrombocytopenia, and mildly increased serum transaminases. Clinicians should consider dengue fever in the differential diagnosis in travelers returning from dengue fever endemic areas of Southeast Asia, Latin America, and Africa. Although early findings are nonspecific, a truncal rash accompanied by leukopenia and thrombocytopenia, if followed by biphasic fever pattern (ie, camelback/saddleback fever curve with relative bradycardia), suggest dengue fever as the primary diagnostic consideration.     

Early clinical recognition of disseminated candidiasis by muscle and skin biopsy.

Disseminated candidiasis was clinically diagnosed by muscle and skin biopsies in two patients with hematologic malignancies. One patient with acute promyelocytic leukemia presented with skin lesions as the sole manifestation of disseminated candidiasis. The other patient had leukemic reticuloendotheliosis and developed fever, severe myalgias, and maculopapular rash while receiving corticosteroid therapy; this patient is the first to have antemortem documentation of candida myositis as the initial manifestation of disseminated candidiasis. These two case reports serve to emphasize the importance of careful observation and early biopsy of skin and muscle to establish the diagnosis and permit early institution of therapy.     

Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations

Objective Clinicians in resource‐poor countries need to identify patients with dengue using readily‐available data. The objective of this systematic review was to identify clinical and laboratory features that differentiate dengue fever (DF) and/or dengue haemorrhagic fever (DHF) from other febrile illnesses (OFI) in dengue–endemic populations. Method Systematic review of the literature from 1990 to 30 October 2007 including English publications comparing dengue and OFI. Results Among 49 studies reviewed, 34 did not meet our criteria for inclusion. Of the 15 studies included, 10 were prospective cohort studies and five were case–control studies. Seven studies assessed all ages, four assessed children only, and four assessed adults only. Patients with dengue had significantly lower platelet, white blood cell (WBC) and neutrophil counts, and a higher frequency of petechiae than OFI patients. Higher frequencies of myalgia, rash, haemorrhagic signs, lethargy/prostration, and arthralgia/joint pain and higher haematocrits were reported in adult patients with dengue but not in children. Most multivariable models included platelet count, WBC, rash, and signs of liver damage; however, none had high statistical validity and none considered changes in clinical features over the course of illness. Conclusions Several individual clinical and laboratory variables distinguish dengue from OFI; however, some variables may be dependent on age. No published multivariable model has been validated. Study design, populations, diagnostic criteria, and data collection methods differed widely across studies, and the majority of studies did not identify specific aetiologies of OFIs. More prospective studies are needed to construct a valid and generalizable algorithm to guide the differential diagnosis of dengue in endemic countries.     

Dengue hemorrhagic fever complicated with acute idiopathic scrotal edema and polyneuropathy

We report a case of an adult with dengue hemorrhagic fever who developed acute idiopathic scrotal edema and glove-and-stocking polyneuropathy. A 54-year-old man who had fever, chills, bone pain, and skin rash for 4 days was admitted. We diagnosed dengue hemorrhagic fever because of fever, gum bleeding, thrombocytopenia, and hemoconcentration, and confirmed the diagnosis by serology. The patient had scrotal and penile edema and distal limb numbness with a glove-and-stocking distribution. After supportive care, the scrotal edema and other symptoms subsided. Patients with dengue hemorrhagic fever may develop scrotal edema caused by plasma leakage.     

Primary dengue infection: what are the clinical distinctions from secondary infection?

To determine the magnitude of the problem posed by primary dengue infection in children and the distinctive clinical clues that may differ from those with secondary infection, 996 children serologically diagnosed with dengue infection and admitted to the Department of Pediatrics, Chulalongkorn Hospital, Bangkok, Thailand between 1988 and 1995 were retrospectively reviewed. One hundred and thirty-nine cases (14.0%) were serologically proved to be primary dengue infection. Of these, 72 were males and 67 were females, with a mean age of 4.8 years. Common manifestations by order of frequency included fever (97.8%), hepatomegaly (71.9%), vomiting (59.0%), decreased appetite (55.4%), coryza (52.5%), drowsiness (39.6%), diarrhea (34.5%), rash (33.8%), abdominal pain (23.0%) and seizure (15.8%). The mean duration of fever before admission was 4.6 days. Common sites of bleeding were skin (41.7%), mucous membrane (14.4%) and the gastrointestinal tract (12.2%). Clinical diagnosis was categorized into dengue fever (22.3%), dengue hemorrhagic fever (60.4%) and dengue shock syndrome (17.3%). Three patients (2.2%) died. Compared with the children with secondary dengue infection (n=139), children with primary dengue infections tended to be younger, presented more commonly with coryza, diarrhea, rash and seizure; and less commonly with vomiting, headache and abdominal pain (p < 0.05). The maximal hematocrit level, the mean difference between maximal and minimal hematocrit values and the maximal percentage of neutrophils were significantly lower in the study group, whereas the maximal percentage of lymphocytes was significantly higher. Dengue fever was more common and dengue shock syndrome was less common in the study group (p < 0.05). This study has emphasized that primary dengue infection is not uncommon and is less severe than secondary infection. Clinical presentations and laboratory findings are somewhat different between the two conditions.     

Changing clinical and biological manifestations of dengue during the dengue-2 epidemic in French Polynesia in 1996/97 – description and analysis in a prospective study

In August 1996 dengue-2 virus was detected in French Polynesia for the first time since 1976. A prospective study was conducted from November 1996 to April 1997. Each time one of 7 physicians suspected dengue, the patient was enrolled and epidemiological, clinical and biological data were recorded. Dengue diagnosis was confirmed by virus isolation and IgM detection. The aims of this study were to find clinical and biological predictive factors constituting a specific profile of dengue (DF) and dengue haemorrhagic fever (DHF/DSS) and to assess the possibility of diagnosing dengue at primary health care level using clinical criteria and basic laboratory parameters. Of 298 clinically suspect cases, 196 (66%) were confirmed as dengue. The association of macular rash, pruritis, low platelet count and leukopenia was statistically predictive of dengue but not clinically, since these four signs occur in many other viral infections. As the prevalence of clinical and biological manifestations varied over time in our study, a specific profile useful for dengue diagnosis cannot be defined. With six cases of DHF, the morbidity of this dengue-2 outbreak was very low despite the sequential infection scheme DEN-3/DEN-2. The clinical expression of dengue could depend on a specific virus strain circulating in a specific population in a particular place, with varying virulence over time.     

3 dengue fever cases,infected during a group tour to the Philippines

We report three dengue fever cases, infected during a group tour to the Philippines. A 58-year old male experienced sudden onset of high fever 5 days after returning to Japan, followed by rash and thrombocytopenia. The other 2 cases experienced similar symptoms. Clinically suspected from the travel history, incubation time and the state of dengue fever epidemic in the Philippines, dengue virus infection was confirmed by the laboratory tests. The incidence and geographical distribution of dengue virus infection have greatly increased in recent years. There have been reports of Japanese travelers who visited dengue endemic countries, infected and developed symptoms after returning home. Dengue virus infection should be included in the differential diagnosis of the patients who develop high fever and rash after returning from tropical areas.