Under-diagnosis of rickettsial disease in clinical practice: A systematic review.
Travel Med Infect Dis
; 26: 7-15, 2018.
Article
en En
| MEDLINE
| ID: mdl-29486240
ABSTRACT
BACKGROUND:
Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars.METHODS:
We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s) scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever. We compared ERD/NERD ratios according to studydesign:
'complete approach' studies, with testing performed in all patients with 'unspecified febrile illness'; versus 'clinical judgement' studies, with testing performed if patients presented with specific symptoms.RESULTS:
In 'complete approach' studies, ERD/NERD ratios were significantly lower, suggesting a considerable under-diagnosis of NERD in 'clinical judgement' studies. Based on these results, we estimate that the diagnosis of rickettsial disease was missed in 66.5% of patients with ST, and in 57.9% of patients with MSF.CONCLUSIONS:
Study design influences the reported eschar rates in ST and MSF significantly. NERD is likely to be a vastly underdiagnosed entity, and clinicians should consider and test for the disease more often. PROSPERO REGISTRATION NUMBER CRD 42016053348.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Infecciones por Rickettsia
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Fiebre
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Systematic_reviews
Límite:
Adult
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Animals
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Travel Med Infect Dis
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
Año:
2018
Tipo del documento:
Article
País de afiliación:
Países Bajos