背景:疟疾快速即时检测现在在许多国家被广泛用于指导发热性疾病患者的初始临床治疗。随着中国最近实现消除疟疾,更好地了解高热疾病的主要非疟疾原因的身份和分布对于提供循证经验治疗政策特别重要。
方法:对已发表的文献进行了系统评价,以表征中国非疟疾性发热性疾病病原体的谱(1980-2015)。在六个数据库中以英语和中文进行了文献检索:OvidMEDLINE,全球卫生,EMBASE,WebofScience™-中国科学引文数据库SM,中国国家知识基础设施(CNKI),和万方医学在线。选择标准包括报告感染或确诊感染,定义为在正常无菌部位的样品中检测或培养的病原体,或当前或过去感染的血清学证据。发表的文章数量,报告了给定的病原体,而不是感染的发生率或患病率。
结果:共筛选了来自中国13个疟疾流行省份的57,181条记录,其中392人符合入选标准,纳入本综述.审查包括1980年至2000年发布的60条(15.3%)记录,2001年至2010年的211条(53.8%)和2011年至2015年的121条(30.9%)。在392条记录中,166人(42.3%)来自中国东部地区,120人(30.6%)来自西南部,102(26.0%)来自中南部,四项(1.0%)是多区域研究。细菌感染在154(39.3%)记录中报告,219例病毒感染(55.9%),四个寄生虫感染(1.0%),1例真菌感染(0.3%),和14(3.6%)出版物报告了一个以上的病原体组。所有年龄段的参与者都被纳入了136项(34.7%)研究,只有75岁的成年人(19.1%),只有17名儿童(4.3%),仅有2例(0.5%)新生儿,162例(41.3%)记录中未说明年龄分布。最常见的细菌病原体包括伤寒沙门氏菌(n=30),Orientia/立克次体(n=31),伯氏柯西氏菌(n=17),钩端螺旋体。(n=15)和布鲁氏菌属。(n=15)。最常报道的病毒病原体包括汉坦病毒/汉坦病毒(n=89),登革热病毒(DENV)(n=76,包括未知血清变型的那些),日本脑炎病毒(n=21),和麻疹病毒(n=15)。我国西部地区数据相对缺乏,以及在新生儿和儿童中,在中国,人们对发热病因的认识存在重大差距。
结论:这篇综述介绍了在中国消除疟疾的过程中,36年来引起高热疾病的非疟疾病原体的情况。这些发现可以为发烧病例的临床管理以及感染监测和预防提供指导,并强调需要标准化操作和报告协议,以更好地了解该国的发烧病因。
BACKGROUND: Rapid point-of-care tests for malaria are now widely used in many countries to guide the initial clinical management of patients presenting with febrile illness. With China having recently achieved malaria elimination, better understanding regarding the identity and distribution of major non-malarial causes of febrile illnesses is of particular importance to inform evidence-based empirical treatment policy.
METHODS: A systematic
review of published literature was undertaken to characterise the spectrum of pathogens causing non-malaria febrile illness in China (1980-2015). Literature searches were conducted in English and Chinese languages in six databases: Ovid MEDLINE, Global Health, EMBASE, Web of Science™ - Chinese Science Citation Database SM, The China National Knowledge Infrastructure (CNKI), and WanFang Med Online. Selection criteria included reporting on an infection or infections with a confirmed diagnosis, defined as pathogens detected in or cultured from samples from normally sterile sites, or serological evidence of current or past infection. The number of published articles, reporting a given pathogen were presented, rather than incidence or prevalence of infection.
RESULTS: A total of 57,181 records from 13 provinces of China where malaria used to be endemic were screened, of which 392 met selection criteria and were included in this review. The
review includes 60 (15.3%) records published from 1980 to 2000, 211 (53.8%) from 2001 to 2010 and 121 (30.9%) from 2011 to 2015;. Of the 392 records, 166 (42.3%) were from the eastern region of China, 120 (30.6%) were from the south-west, 102 (26.0%) from south-central, and four (1.0%) were multi-regional studies. Bacterial infections were reported in 154 (39.3%) records, viral infections in 219 (55.9%), parasitic infections in four (1.0%), fungal infections in one (0.3%), and 14 (3.6%) publications reported more than one pathogen group. Participants of all ages were included in 136 (34.7%) studies, only adults in 75 (19.1%), only children in 17 (4.3%), only neonates in two (0.5%) and the age distribution was not specified in 162 (41.3%) records. The most commonly reported bacterial pathogens included Typhoidal Salmonella (n = 30), Orientia/ Rickettsia tsutsugamushi (n = 31), Coxiella burnetii (n = 17), Leptospira spp. (n = 15) and Brucella spp. (n = 15). The most commonly reported viral pathogens included Hantavirus/Hantaan virus (n = 89), dengue virus (DENV) (n = 76 including those with unknown serovars), Japanese encephalitis virus (n = 21), and measles virus (n = 15). The relative lack of data in the western region of the country, as well as in in neonates and children, represented major gaps in the understanding of the aetiology of
fever in China.
CONCLUSIONS: This review presents a landscape of non-malaria pathogens causing febrile illness in China over 36 years as the country progressed toward malaria elimination. These findings can inform guidelines for clinical management of
fever cases and infection surveillance and prevention, and highlight the need to standardize operational and reporting protocols for better understanding of
fever aetiology in the country.