A predictive score for hypotension in patients with confirmed dengue fever in Cayenne Hospital, French Guiana

Bayesian Analysis Used to Identify Clinical and Laboratory Variables Capable of Predicting Progression to Severe Dengue among Infected Pediatric Patients

The current contribution aimed to evaluate the capacity of the naive Bayes classifier to predict the progression of dengue fever to severe infection in children based on a defined set of clinical conditions and laboratory parameters. This case-control study was conducted by reviewing patient files in two public hospitals in an endemic area in Mexico. All 99 qualifying files showed a confirmed diagnosis of dengue. The 32 cases consisted of patients who entered the intensive care unit, while the 67 control patients did not require intensive care. The naive Bayes classifier could identify factors predictive of severe dengue, evidenced by 78% sensitivity, 91% specificity, a positive predictive value of 8.7, a negative predictive value of 0.24, and a global yield of 0.69. The factors that exhibited the greatest predictive capacity in the model were seven clinical conditions (tachycardia, respiratory failure, cold hands and feet, capillary leak leading to the escape of blood plasma, dyspnea, and alterations in consciousness) and three laboratory parameters (hypoalbuminemia, hypoproteinemia, and leukocytosis). Thus, the present model showed a predictive and adaptive capacity in a small pediatric population. It also identified attributes (i.e., hypoalbuminemia and hypoproteinemia) that may strengthen the WHO criteria for predicting progression to severe dengue.

About the need to address pediatric health inequalities in French Guiana : a scoping review

INTRODUCTION

French Guiana is a French overseas territory in South America, marked by poverty and inequalities. Access to different services, including healthcare, is unequal depending on where people live. Several studies showed that among adults, the most precarious individuals had greater incidences of chronic and infectious diseases. Although the median age of the population living in this territory is 25, there is no specific focus on the pediatric population although it is documented that socioeconomic inequalities have an impact on child health. The objective of this scoping review is to shed light on health challenges concerning children living in French Guiana.

METHODS

A literature search was performed on PubMed to identify relevant articles, and additional references were added if within the scope of this review.

RESULTS

A total of 106 publications were reviewed. Perinatal health issues were linked to a high rate of teenage pregnancies with poor medical follow-up leading to complications such as preterm deliveries and congenital malformations and abnormalities. Infectious diseases were a significant burden with worrisome vaccination coverage figures for some bacterial infections, partly explaining a high mortality rate attributable to infectious diseases. Herbicide poisoning with paraquat was reported in children, and environment-related concerns such as wild animal attacks as well as lead and mercury exposure were reported. Some children living in remote Amerindian communities had a higher suicide rate than in mainland France, and chronic diseases such as sickle cell disease were reported to have more transfusion-related complications.

CONCLUSION

Children living in French Guiana have worse pediatric health indicators in comparison with children from mainland France.

Diagnostic accuracy and predictive value in differentiating the severity of dengue infection

OBJECTIVE

To review the diagnostic test accuracy and predictive value of statistical models in differentiating the severity of dengue infection.

METHODS

Electronic searches were conducted in the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE (complete), PubMed and Scopus. Eligible studies to be included in this review were cohort studies with participants confirmed by laboratory test for dengue infection and comparison among the different severity of dengue infection by using statistical models. The methodological quality of the paper was assessed by independent reviewers using QUADAS-2.

RESULTS

Twenty-six studies published from 1994 to 2017 were included. Most diagnostic models produced an accuracy of 75% to 80% except one with 86%. Two models predicting severe dengue according to the WHO 2009 classification have 86% accuracy. Both of these logistic regression models were applied during the first three days of illness, and their sensitivity and specificity were 91-100% and 79.3-86%, respectively. Another model which evaluated the 30-day mortality of dengue infection had an accuracy of 98.5%.

CONCLUSION

Although there are several potential predictive or diagnostic models for dengue infection, their limitations could affect their validity. It is recommended that these models be revalidated in other clinical settings and their methods be improved and standardised in future.

Atypical and severe manifestations of chikungunya virus infection in French Guiana: A hospital-based study

BACKGROUND

French Guiana (FG) was the first country in South America to declare chikungunya virus infection (CHIKV). The outbreak affected about 16,000 persons between February 2014 and October 2015, with several atypical cases, but only two fatal cases. We aimed to describe the clinical presentation of patients hospitalized for CHIKV infection, to estimate and identify risk factors of unusual and severe forms in adult patients.

MATERIALS AND METHODS

A monocentric retrospective study was conducted in Cayenne hospital, the main city and the main hospital in FG, from March 1st 2014 to August 31st 2015. All patients admitted for at least one night with a biological diagnosis of CHIKV infection during the 2014/2015 outbreak were included, except pregnant women and children under 15 years.

RESULTS

During the study period, 285 patients with a diagnosis of CHIKV infection were hospitalized in Cayenne hospital, among whom 96 nonpregnant adults were studied. Five were classified as severe forms (5.2%) and 23 as unusual forms (23.9%). The most frequent atypical and/or severe form was neurological (n = 20), followed by cardio-respiratory failure (acute respiratory failure n = 4, acute heart failure n = 2), digestive and hepatic disorders (acute hepatitis n = 3, acute pancreatitis n = 2), renal disorders (acute renal failure n = 5) and muscular impairment (rhabdomyolysis n = 3).

CONCLUSION

During the outbreak, hospitalizations were frequent, particularly for common forms, driven by algic clinical presentations and concerns due to the novelty of this infection. Despite atypical neurological and liver forms of CHIKV infection, case-fatality was low in French Guiana. No specific risk factor of atypical and/or severe forms was found in our study.