背景:猴痘(mpox)的全球传播显着增加,特别是在非流行国家。
目的:我们旨在调查1970年至2023年与水痘相关的临床症状的变化,并探讨它们之间的相互关系。
方法:在本系统综述和荟萃分析中,搜索了3个电子数据库,以查找1970年1月至2023年4月进行的英语同行评审研究,这些研究报告了确诊的水痘病例中的任何症状。我们将水痘流行病分为3个时期:1970-2002年(第1期,在非洲地区),2003-2021年(第二阶段,非洲以外的流行病),和2022-2023年(第3期,全球疫情)。按照PRISMA准则,我们进行了荟萃分析,以估计每种症状的合并患病率.使用网络分析对症状之间的相关性进行分析和可视化。
结果:荟萃分析纳入了61项研究,这些研究报告了1期的720例患者中的21种症状,2期的1756例患者中的39种症状以及3期的12,277例患者中的37种症状。所有三个时期的患者中最常见的症状是皮疹(第1期:92.6%,95%CI78.2%-100%;第2期:100%,95%CI99.9%-100%;第3期:94.8%,95%CI90.9%-98.8%),其次是淋巴结病(第1期:59.8%,95%CI50.3%-69.2%;第二阶段:74.1%,95%CI64.2%-84.1%;第3期:61.1%,95%CI54.2%-68.1%)。发烧(99%,95%CI97%-100%),淋巴结肿大(80.5%,95%CI75.4%-85.0%),头痛(69.1%,95%CI4%-100%)是第1期的主要症状,第3期明显减少:37.9%,31.2%,和28.7%,分别。寒战/严寒(73.3%,95%CI60.9%-85.7%),疲劳(68.2%,95%CI51.6%-84.8%),和吞咽困难/吞咽困难(61.2%,95%CI10.5%-100%)在第2阶段出现为主要新症状,在第3阶段显着降低。与前2个时期相比,第3期的大多数其他症状保持不变或减少。在第2阶段,恶心/呕吐的相关性最高(有13种症状),与淋巴结肿大(r=0.908)和结膜炎(r=0.900)呈高度正相关。相比之下,皮疹和头痛是相关性最高的2个症状(分别为21个和21个症状,分别)在第3期与发烧呈高度正相关(r分别为0.918和0.789)。
结论:水痘患者的症状表现变得更加多样化,导致它们的相关性增加。尽管皮疹的患病率保持稳定,其他症状有所减轻。有必要监视水痘的演变性质以及临床特征的相应变化。流行病国家可能会将注意力转移到症状和高协同风险之间的潜在关联上。
背景:PROSPERO注册:CRD42023403282;http://tinyurl.com/yruuas5n。
BACKGROUND: The worldwide spread of monkeypox (mpox) has witnessed a significant increase, particularly in nonendemic countries.
OBJECTIVE: We aimed to investigate the changing clinical symptoms associated with mpox from 1970 to 2023 and explore their interrelations.
METHODS: In this systematic
review and meta-analysis, 3 electronic databases were searched for English peer-reviewed studies conducted from January 1970 to April 2023 that reported any symptoms among confirmed mpox cases. We categorized the mpox epidemics into 3 periods: 1970-2002 (period 1, within the African region), 2003-2021(period 2, epidemics outside Africa), and 2022-2023 (period 3, worldwide outbreak). Following PRISMA guidelines, a meta-analysis was performed to estimate the pooled prevalence for each symptom. The correlation among symptoms was analyzed and visualized using network analysis.
RESULTS: The meta-analysis included 61 studies that reported 21 symptoms in 720 patients from period 1, 39 symptoms in 1756 patients from period 2, and 37 symptoms in 12,277 patients from period 3. The most common symptom among patients from all 3 periods was rash (period 1: 92.6%, 95% CI 78.2%-100%; period 2: 100%, 95% CI 99.9%-100%; and period 3: 94.8%, 95% CI 90.9%-98.8%), followed by lymphadenopathy (period 1: 59.8%, 95% CI 50.3%-69.2%; period 2: 74.1%, 95% CI 64.2%-84.1%; and period 3: 61.1%, 95% CI 54.2%-68.1%). Fever (99%, 95% CI 97%-100%), enlarged lymph nodes (80.5%, 95% CI 75.4%-85.0%), and headache (69.1%, 95% CI 4%-100%) were the main symptoms in period 1, with a significant decrease in period 3: 37.9%, 31.2%, and 28.7%, respectively. Chills/rigors (73.3%, 95% CI 60.9%-85.7%), fatigue (68.2%, 95% CI 51.6%-84.8%), and dysphagia/swallowing difficulty (61.2%, 95% CI 10.5%-100%) emerged as primary new symptoms in period 2 and decreased significantly in period 3. Most other symptoms remained unchanged or decreased in period 3 compared to the former 2 periods. Nausea/vomiting had the highest degree of correlation (with 13 symptoms) and was highly positively correlated with lymphadenopathy (r=0.908) and conjunctivitis (r=0.900) in period 2. In contrast, rash and headache were 2 symptoms with the highest degree of correlation (with 21 and 21 symptoms, respectively) in period 3 and were highly positively correlated with fever (r=0.918 and 0.789, respectively).
CONCLUSIONS: The manifestation of symptoms in patients with mpox has become more diverse, leading to an increase in their correlation. Although the prevalence of rash remains steady, other symptoms have decreased. It is necessary to surveil the evolving nature of mpox and the consequential changes in clinical characteristics. Epidemic countries may shift their focus on the potential association among symptoms and the high synergy risk.
BACKGROUND: PROSPERO Registration: CRD42023403282; http://tinyurl.com/yruuas5n.