广州市1例境外误诊登革热的新型冠状病毒肺炎病例调查

Investigation of an overseas COVID-19 misdiagnosed as dengue fever in Guangzhou

对1例境外误诊为登革热的新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)进行流行病学调查,探讨被误诊的可能关键环节,为制定登革热流行期的新型冠状病毒肺炎防控策略提供依据。运用描述性流行病学方法对COVID-19病例及其密切接触者和可疑感染来源进行调查和分析,采用RT-PCR方法进行新型冠状病毒核酸检测、免疫层析法进行登革热病毒抗原、抗体检测。结果该COVID-19病例于病前14 d有武汉和柬埔寨居住史,2020年1月23日发病,在柬埔寨"某集团医院"门诊就诊1月30日检测登革热抗原NS1结果为可疑阳性,登革热抗体IgM、IgG结果均为阴性,该医院诊断为"可疑登革热"。1月31日凌晨,病例入境广州在某酒店隔离观察。经酒店驻点医务人员为病例采血送海珠区疾病预防控制中心以免疫层析法(胶体金)排查登革热,结果登革病毒NS1抗原阴性,IgM、IgG抗体均为阴性,排除"登革热"。1月31日医院采集咽拭子标本检测,结果新型冠状病毒核酸阳性,以"新型冠状病毒肺炎疑似病例"网络直报,2月1日广州市疾病预防控制中心复核新型冠状病毒核酸阳性,以"新型冠状病毒肺炎确诊病例"进行订正。COVID-19早期症状与登革热相似。在登革热流行期,做好登革热与COVID-19早期鉴别诊断非常重要,早诊早治,是预防疫情扩散的关键。

Analysis of a case of COVID-19 and dengue fever misdiagnosed key links,we provide basis for the development of COVID-19 prevention and control strategy in the epidemic period of dengue fever.We used descriptive epidemiological method to investigate and analyze the case,their close contacts and suspected sources of infection,tested SARS-CoV-2 by RT-PCR and dengue virus antigen and antibody by immunochromatography.The case had lived in Wuhan and Cambodia 14 days,and was diagnosed as suspected dengue fever in overseas hospital on January 23 rd,2020.On January30,dengue antigen NS1 of the patient was tested suspiciously positive in an outpatient clinic in a"group hospital"in Cambodia,and negative for dengue antibodies IgM and IgG.The patient was diagnosed as"suspected dengue fever".In the early morning of January 31,the case entered Guangzhou and was quarantined in a hotel for observation.Blood samples were collected by medical staff at the hotel and sent to the Center for Disease Control and Prevention in Haizhu District for dengue fever detection by immunochromatography(colloidal gold).The results showed that the Dengue virus NS1 antigen was negative,IgM and IgG antibodies were negative,and"dengue fever"was excluded.On January 31,the hospital took a throat swab sample and the result was positive from SARS-CoV-2 nucleic acid test,which was reported as a"suspected COVID-19 case"on the network.On February 1,the Guangzhou Municipal Center for Disease Control and Prevention reviewed SARS-CoV-2 nucleic acid test and revised it as a"confirmed COVID-19 case".Some early symptoms of COVID-19 are similar with dengue fever.In the epidemic period of dengue fever,it is very important to make a good early diagnosis between dengue fever and COVID-19,early diagnosis and treatment is the key to prevent the spread of disease epidemic.