背景:登革热病是由登革病毒引起的,由伊蚊在全球热带和亚热带地区传播。尽管大多数感染者有良性发热或没有明显症状,一小部分会出现严重的登革热,在发热阶段后发生的潜在致命疾病。许多研究已经确定了预测不同人群和时间进程中登革热严重程度的因素。为了帮助找到适用于远程设置的实用方法,我们重点调查了泰国-缅甸跨境地区与严重登革热相关的早期因素。
方法:这项回顾性病例对照研究是为了确定儿童人群中导致严重登革热的因素。我们回顾了Maesot总医院收治的0-19岁登革热感染患者的医院记录,位于泰国-缅甸跨境地区附近,2017年至2022年。收集并分析发病前5天的医疗数据和结果。
结果:本研究纳入144例血清学确诊为登革热感染的患者,严重病例43例,非严重病例101例。在生物因素中,在单变量分析中,作为一名婴儿,属于缅甸的一个种族群体,与严重登革热存在显着关联。多变量logistic回归分析显示粘膜出血的存在(校正OR5.39,95%CI1.06-27.52,P=0.043),血细胞比容变化≥10%(校正OR3.68,95%CI1.15-11.74,P=0.028),在疾病的前5天,血清白蛋白<35g/L(校正OR8.10,95%CI2.55-25.72,P<0.001)与发生严重登革热显着相关。
结论:本研究支持使用某些WHO警告信号和发热期血细胞比容变化来预测低资源环境中的小儿重症登革热。诸如非常年轻的年龄和种族群体等潜在因素需要进一步探索,以确定导致严重登革热感染的风险。
BACKGROUND: Dengue disease is caused by dengue virus, which is transmitted by Aedes mosquitoes in tropical and subtropical regions worldwide. Although most infected individuals have benign febrile illness or no apparent symptoms, a small percentage develop severe dengue, a potentially fatal condition that occurs after a febrile stage. Many studies have identified factors predicting dengue severity among different populations and time courses. To help find practical approaches applicable in remote settings, we focused on the investigation of early factors associated with severe dengue in Thai-Myanmar cross-border region.
METHODS: This retrospective case-control study was performed to determine factors contributing to severe dengue in the pediatric population. We reviewed the hospital records of patients with dengue infection aged 0-19 years who were admitted to Maesot General Hospital, situated near the Thai-Myanmar cross-border region, between 2017 and 2022. Medical data during the first 5 days of illness and outcomes were collected and analyzed.
RESULTS: This study included 144 patients with a serologically confirmed diagnosis of dengue infection, with 43 severe and 101 non-severe cases. Among biological factors, being an infant and belonging to an ethnic group in Myanmar showed a significant association with severe dengue in the univariable analysis. Multivariable logistic regression revealed that the presence of mucosal bleeding (adjusted OR 5.39, 95% CI 1.06-27.52, P = 0.043), a change in hematocrit ≥ 10% (adjusted OR 3.68, 95% CI 1.15-11.74, P = 0.028), and serum albumin < 35 g/L (adjusted OR 8.10, 95% CI 2.55-25.72, P < 0.001) during the first 5 days of illness were significantly associated with developing severe dengue.
CONCLUSIONS: This study supports the use of certain WHO warning signs and hematocrit change during febrile phase to predict pediatric severe dengue in low-resource settings. Potential factors such as very young age and ethnic groups warrant further exploration to identify risks contributing to severe dengue infection.