NS1抗原快篩陰性不能排除登革熱——南部某醫學中心2023年的診治經驗

A Negative Point-of-care Result does not Exclude Dengue Fever: The Diagnostic Experience of A Medical Center in Southern Taiwan from the 2023 Dengue Outbreak

2023年爆發的登革熱疫情，是自2014年與2015年兩次大流行以來最為嚴重的一次。在登革熱大流行期間，即時且正確的診斷對於登革熱防治至關重要。本研究回溯南部某醫學中心於2023年共158位確診登革熱的患者，分析此族群中登革熱NS1抗原快速檢驗陰性和陽性群組的臨床差異；其中登革熱NS1抗原快速檢驗陰性者有22人（13.9%）。在症狀方面，登革熱NS1抗原快速檢驗陰性組較常見呼吸道症狀如咳嗽（31.8% vs.27.2%，和喉嚨痛（22.7% vs.14.7%），而快篩陽性組有較多腸胃道症狀，如腹痛（0% vs.17.6%, p=0.027）和噁心嘔吐（13.6% vs.33.8%）。登革熱NS1抗原快速檢驗陰性組出現警示徵象的比率顯著低於快篩陽性組（22.7% vs.49.3%, p=0.02）。結果顯示登革熱NS1抗原快速檢驗陰性患者可能呈現較輕微或非典型症狀。此外，登革熱NS1抗原快速檢驗陰性組即時住院的比率顯著低於檢驗陽性組（22.7% vs. 85.3%, p<0.001）。初始登革熱NS1抗原快速檢驗陰性結果可能延遲了防疫措施的實施。因此，在登革熱流行季節中，即使登革熱NS1抗原快速檢驗陰性，仍應考慮登革熱的可能性，尤其是具有非典型症狀的病人。

The dengue outbreak in Taiwan in 2023 was the most severe epidemic since the 2014 and 2015 pandemics . The prompt and accurate diagnosis of dengue fever is critical for effectively controlling dengue during an outbreak. This study aimed to investigate the differences between patients with NS1-positive and NS1-negative dengue fever . In this retrospective analysis, 158 patients diagnosed with dengue fever at a medical center in southern Taiwan were enrolled. Among these, 22 patients (13.9%) were NS1-negative. The NS1-negative patients had significantly fewer cases with warning signs compared to NS1-positive patients (22.7% vs. 49.3%, p=0.02). Interestingly, the NS1-negative patients tended to have more respiratory symptoms, including cough (31.8% vs. 27.2%, p=0.654) and sore throat (22.7% vs. 14.7%, p=0.339). In contrast, the NS1-positive patients were more likely to present with gastrointestinal symptoms, such as abdominal pain (0% vs. 17.6%, p=0.027) and nausea/vomiting (13.6% vs. 33.8%, p=0.081). Additionally, the NS1-negative patients had a significantly lower rate of hospitalization and isolation compared to NS1-positive patients (22.7% vs. 85.3%, p<0.001). The initial NS1-negative test report may delay the quarantine measures and policies of control and prevention. This study suggests that patients with NS1-negative dengue fever may present with milder or atypical dengue symptoms compared to their NS1-positive counterparts. These results highlight the importance of remaining vigilant for dengue fever among patients during dengue fever epidemics even when the NS1 rapid tests are negative.