A Comparative Study of Leptospirosis and Dengue in Thai Children 英文参考文献.docVIP

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A Comparative Study of Leptospirosis and Dengue in Thai Children 英文参考文献.doc

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A Comparative Study of Leptospirosis and Dengue in Thai Children 英文参考文献

AComparativeStudyofLeptospirosisandDenguein ThaiChildren DanielH.Libraty1*,KhinS.A.Myint2,ClintonK.Murray3,RobertV.Gibbons2,MammenP.Mammen2, TimothyP.Endy2,WenjunLi4,DavidW.Vaughn2,AnandaNisalak2,SiripenKalayanarooj5,DuaneR. Hospenthal3,SharoneGreen1,AlanL.Rothman1,FrancisA.Ennis1 1CenterforInfectiousDiseaseandVaccineResearch,UniversityofMassachusettsMedicalSchool,Worcester,Massachusetts,UnitedStatesofAmerica,2Departmentof Virology,USArmyMedicalComponent,ArmedForcesResearchInstituteforMedicalSciences,Bangkok,Thailand,3BrookeArmyMedicalCenter,Ft.SamHouston,Texas, UnitedStatesofAmerica,4DepartmentofPreventiveandBehavioralMedicine,UniversityofMassachusettsMedicalSchool,Worcester,Massachusetts,UnitedStatesof America,5DepartmentofPediatrics,QueenSirikitNationalInstituteofChildHealth,Bangkok,Thailand Abstract Background: Leptospirosis is an emerging zoonosis that is often under-recognized in children and commonly confused with dengue in tropical settings. An enhanced ability to distinguish leptospirosis from dengue in children would guide cliniciansandpublichealthpersonnelintheappropriateuseoflimitedhealthcareresources. Methodology/PrincipalFindings:Weconductedaprospective,hospital-based,studyofchildrenwithacutefebrileillnesses anddengueinThailand.Amongthechildrenwithoutdengue,weidentifiedthosewithleptospirosisusinganti-leptospira IgM and microscopic agglutination titers in paired acute and convalescent blood samples. We then performed a case-control comparison of symptoms, signs, and clinical laboratory values between children with leptospirosis and dengue. In a semi-rural region of Thailand, leptospirosis accounted for 19% of the non-dengue acute febrile illnesses amongchildrenpresentingduringtherainyseason.Noneofthechildrenwithleptospirosiswerecorrectlydiagnosedatthe timeofhospitaldischarge,andonethird(33%)wereerroneouslydiagnosedasdengueorscrubtyphus.Apredictivemodel to distinguish pediatric leptospirosis from dengue was generated using three variables: the absolute