■肾综合征出血热(HFRS)是一种自然流行病,可由汉坦病毒(HTNV)引起。疟疾是由疟原虫引起的,可以通过蚊虫叮咬传播。这些疾病共有的相似表现对临床医生的鉴别诊断提出了挑战。特别是,再加上假阳性血清学检测.
■一名46岁男子因发烧和寒战入院超过10天,并因曾前往疟疾流行地区和HTNV-免疫球蛋白M(IgM)检测阳性而被怀疑与HFRS和疟疾共同感染。虽然白细胞增多,血小板减少症,肾损伤,淋巴细胞增多,在住院期间观察到白细胞介素-6和降钙素原的过度表达,低血压,少尿,未观察到HFRS病程的多尿阶段。相反,发现了典型的疟疾症状,包括红细胞和血红蛋白水平逐渐下降,伴有贫血迹象。此外,因为患者没有接触HFRS流行区的病史,暴露于感染HTNV的啮齿动物,或HTNV-IgG阳性,IgM的假血清学检测可能是由多种因素引起的,HFRS与疟疾合并感染被排除。
■错误的血清学检查很容易引起误诊,特别是IgM测试可能受到各种因素的影响。结合健康史,流行病学,体检,涉及常规实验室参数测试的特定检查的精确应用以及公认的方法,例如免疫色谱(ICG)测试,实时逆转录聚合酶链反应(PCR),和蛋白质印迹(WB),熟悉具有相似表现的疾病将有助于临床治疗中的精确诊断。
UNASSIGNED: Hemorrhagic fever with renal syndrome (HFRS) is a natural epidemic disease that can be caused by the Hantaan virus (HTNV). Malaria is caused by plasmodium and can be transmitted by a mosquito bite. The similar manifestations shared by these disorders pose a challenge for clinicians in differential diagnosis, in particular, coupled with a false-positive serological test.
UNASSIGNED: A 46-year-old man was admitted for fever and chills for over 10 days and was suspected of being co-infected with HFRS and malaria due to a history of travel to malaria-endemic areas and a positive HTNV-immunoglobulin M (IgM) test. Although leukocytosis, thrombocytopenia, renal injury, lymphocytosis, overexpression of interleukin-6, and procalcitonin were observed during the hospitalization, the hypotensive, oliguria, and polyuria phases of the HFRS course were not observed. Instead, typical symptoms of malaria were found, including a progressive decrease in erythrocytes and hemoglobin levels with signs of anemia. Furthermore, because the patient had no history of exposure to HFRS endemic areas, exposure to an HTNV-infected rodent, or a positive HTNV-IgG test, and false serological tests of IgM can be caused by various factors, the HFRS coinfection with malaria was ruled out.
UNASSIGNED: Misdiagnosis can be easily induced by a false serological test, in particular the IgM test which can be influenced by various factors. A combination of health history, epidemiology, physical examination, precise application of specific examinations involving tests of conventional laboratory parameters as well as well-accepted methods such as the immunochromatographic (ICG) test, real-time reverse transcription-polymerase chain reaction (PCR), and Western blot (WB), and acquaintance with disorders with similar manifestations will contribute to the precise diagnosis in clinical treatment.