裂谷热(RVF)正在兴起,被忽视,蚊媒病毒人畜共患病与显著的发病率,死亡率和不断扩大的地理范围。人类的临床体征和症状是非特异性的,病例定义各不相同。我们回顾并分析了人类RVF的临床表现。
在这篇系统综述和荟萃分析中,我们在不同的日期进行了搜索,Embase(从1947年到2019年10月13日),Medline(1946年至2019年10月14日),全球健康(1910年至2019年10月15日),和WebofScience(1970年至2019年10月15日)数据库。研究发表在英文,报告人类症状的频率,和实验室确认的RVF包括在内。动物研究,在无症状志愿者中进行的研究,以及无法估计比例的单个病例报告,被排除在外。使用改良的Hoy和Brooks等工具进行质量评估,数据被提取,以及使用随机效应荟萃分析计算的合并频率估计值。
在检索到的3765篇文章中,在系统评价和荟萃分析中纳入了不到1%(32篇).报告了9种RVF临床综合征,包括一般发热,肾,胃肠,肝,出血性,视觉,神经学,心肺,和产科综合症。最常见的临床表现包括发热(81%;95%置信区间(CI)69-91;[26项研究,1286名患者]),肾功能衰竭(41%;23-59;[4,327]),恶心(38%;12-67;[6,325]),黄疸(26%;16-36;[15,393]),出血性疾病(26%;17-36;[16,277]),部分失明(24%;7-45;[11,225]),脑炎(21%;11-33;[4,327]),咳嗽(4%;0-17;[4,11]),和流产(54%)。死亡发生率为21%(95%CI14-29;[16项研究,328例患者])的病例,大多数人都住院了。
这项研究将人类RVF疾病的复杂症状划分为综合征。这种方法可能会提高案例定义和检测率,影响疫情控制,提高公众对RVF的认识,并随后通知“单一健康”政策。这项研究提供了对RVF临床表现比例的汇总估计以及对临床综合征的叙述性描述。然而,审查的大多数研究是小样本量的病例系列,主要是住院患者和门诊患者,并稀疏或使用广义类别术语捕获症状。
Rift Valley fever (RVF) is an emerging, neglected, mosquito-borne viral zoonosis associated with significant morbidity, mortality and expanding geographical scope. The clinical signs and symptoms in humans are non-specific and case definitions vary. We reviewed and analysed the clinical manifestations of RVF in humans.
In this systematic
review and meta-analysis we searched on different dates, the Embase (from 1947 to 13th October 2019), Medline (1946 to 14th October 2019), Global Health (1910 to 15th October 2019), and Web of Science (1970 to 15th October 2019) databases. Studies published in English, reporting frequency of symptoms in humans, and laboratory confirmed RVF were included. Animal studies, studies among asymptomatic volunteers, and single case reports for which a proportion could not be estimated, were excluded. Quality assessment was done using a modified Hoy and Brooks et al tool, data was extracted, and pooled frequency estimates calculated using random effects meta-analysis.
Of the 3765 articles retrieved, less than 1% (32 articles) were included in the systematic
review and meta-analysis. Nine RVF clinical syndromes were reported including the general febrile, renal, gastrointestinal, hepatic, haemorrhagic, visual, neurological, cardio-pulmonary, and obstetric syndromes. The most common clinical manifestations included fever (81%; 95% Confidence Interval (CI) 69-91; [26 studies, 1286 patients]), renal failure (41%; 23-59; [4, 327]), nausea (38%; 12-67; [6, 325]), jaundice (26%; 16-36; [15, 393]), haemorrhagic disease (26%; 17-36; [16, 277]), partial blindness (24%; 7-45; [11, 225]), encephalitis (21%; 11-33; [4, 327]), cough (4%; 0-17; [4, 11]), and miscarriage (54%) respectively. Death occurred in 21% (95% CI 14-29; [16 studies, 328 patients]) of cases, most of whom were hospitalised.
This study delineates the complex symptomatology of human RVF disease into syndromes. This approach is likely to improve case definitions and detection rates, impact outbreak control, increase public awareness about RVF, and subsequently inform \'one-health\' policies. This study provides a pooled estimate of the proportion of RVF clinical manifestations alongside a narrative description of clinical syndromes. However, most studies reviewed were case series with small sample sizes and enrolled mostly in-patients and out-patients, and captured symptoms either sparsely or using broad category terms.