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Velut G, de Laval F, Berry M, Dufour Gaume F, André N, Epelboin L, Lavergne A, Enfissi A, Djossou F, Rousset D, Briolant S. Etiology of Acute Febrile Illnesses in Adults in the Defense Community in French Guiana. Am J Trop Med Hyg 2024; 110:819-825. [PMID: 38377600 PMCID: PMC10993844 DOI: 10.4269/ajtmh.22-0638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/13/2023] [Indexed: 02/22/2024] Open
Abstract
In tropical countries, acute febrile illnesses represent a complex clinical problem for general practitioners. We describe the prevalence of different etiologies of acute febrile illnesses occurring among French service members and their families, excluding children, in general practice in French Guiana. From June 2017 to March 2020, patients with a fever ≥37.8°C with a duration of less than 15 days who sought medical care at the army medical centers in Cayenne and Kourou were prospectively enrolled. Based on clinical presentation, blood, urine, nasopharyngeal, and stool samples were collected for diagnostic testing for viruses, bacteria, and parasites (by direct examination, microscopic examination of blood smears, culture, serology, or polymerase chain reaction), and standardized biological tests were systematically performed. Among 175 patients retained for analysis, fever with nonspecific symptoms was predominant (46.9%), with 10 Plasmodium vivax malaria cases, 8 dengue infections, and 6 cases of Q fever. The second most frequent cause of acute febrile illness was upper respiratory tract infections (32.0%) due to influenza virus (n = 18) or human rhinovirus (n = 10). Among the causes of acute febrile illness in French Guiana, clinicians should first consider arboviruses and malaria, as well as Q fever in cases of elevated C-reactive protein with nonspecific symptoms and influenza in cases of signs and symptoms associated with upper respiratory tract infections. Despite an expanded microbiological search, the etiology of 51.4% of acute febrile illnesses remain unknown. Further investigations will be necessary to identify the etiology of acute febrile illnesses, including new pathogens, in French Guiana.
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Affiliation(s)
- Guillaume Velut
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | - Franck de Laval
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
- Aix-Marseille Université, INSERM, Institut de Recherche pour le Développement, Economic and Social Sciences, Health Systems, and Medical Informatics, Marseille, France
| | - Morgane Berry
- Centre Médical Interarmées de Cayenne, Cayenne, French Guiana
| | | | - Nathalie André
- Direction Interarmées du Service de Santé des Forces Armées en Guyane, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, et Centre d’investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Anne Lavergne
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Antoine Enfissi
- Laboratoire de Virologie, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Felix Djossou
- Service des Maladies Infectieuses et Tropicales, et Centre d’investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Dominique Rousset
- Laboratoire de Virologie, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Sébastien Briolant
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs – Infections Tropicales et Méditerranéennes, Marseille, France
- Institut Hospitalo-Universitaire – Méditerranée Infection, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
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Bressan CDS, Teixeira MDLB, Gouvêa MIFDS, de Pina-Costa A, Santos HFP, Calvet GA, Lupi O, Siqueira AM, Valls-de-Souza R, Valim C, Brasil P. Challenges of acute febrile illness diagnosis in a national infectious diseases center in Rio de Janeiro: 16-year experience of syndromic surveillance. PLoS Negl Trop Dis 2023; 17:e0011232. [PMID: 37011087 PMCID: PMC10101631 DOI: 10.1371/journal.pntd.0011232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/13/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Acute febrile illnesses (AFI) are a frequent chief complaint in outpatients. Because the capacity to investigate the causative pathogen of AFIs is limited in low- and middle-income countries, patient management may be suboptimal. Understanding the distribution of causes of AFI can improve patient outcomes. This study aims to describe the most common etiologies diagnosed over a 16-years period in a national reference center for tropical diseases in a large urban center in Rio de Janeiro, Brazil. METHODS From August 2004-December 2019, 3591 patients > 12 years old, with AFI and/or rash were eligible. Complementary exams for etiological investigation were requested using syndromic classification as a decision guide. Results. Among the 3591 patients included, endemic arboviruses such as chikungunya (21%), dengue (15%) and zika (6%) were the most common laboratory-confirmed diagnosis, together with travel-related malaria (11%). Clinical presumptive diagnosis lacked sensitivity for emerging diseases such as zika (31%). Rickettsia disease and leptospirosis were rarely investigated and an infrequent finding when based purely on clinical features. Respiratory symptoms increased the odds for the diagnostic remaining inconclusive. CONCLUSIONS Numerous patients did not have a conclusive etiologic diagnosis. Since syndromic classification used for standardization of etiological investigation and presumptive clinical diagnosis had moderate accuracy, it is necessary to incorporate new diagnostic technologies to improve diagnostic accuracy and surveillance capacity.
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Affiliation(s)
| | - Maria de Lourdes Benamor Teixeira
- Laboratory of Epidemiology Research and Social Determinants of Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Anielle de Pina-Costa
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | | | - Guilherme Amaral Calvet
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Otilia Lupi
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andre Machado Siqueira
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Valls-de-Souza
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Patrícia Brasil
- Acute Febrile Illnesses Service, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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Yaya-Lancheros N, Polo-Terán LJ, Faccini-Martínez ÁA, Hidalgo-Díaz M. [Epidemiological surveillance system for the acute febrile syndrome in Villeta, Colombia]. Rev Salud Publica (Bogota) 2023; 21:340-348. [PMID: 36753179 DOI: 10.15446/rsap.v21n3.56122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/29/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To generate a preliminary proposal of an integral surveillance system for the acute febrile syndrome in Villeta municipality, Cundinamarca department, with the goal to establish a collection processes and data capture in the presentation of human and animal cases. MATERIALS AND METHODS A database was generated from a cross-sectional retrospective study of 40 sheets of mandatory reporting for suspected dengue patients collected during October 2011 and March 2013 from Hospital Salazar of Villeta. These data were analyzed by the Epiinfo 7 program. Also, because of the evidence of leptospirosis and rickettsial circulation in this municipality and whereas these etiologies are zoonotic, an adaptation was made regarding the event in dogs. These results allowed to design the proposed system, including operational surveillance case definitions for febrile etiologies, action algorithms and reporting tools. RESULTS Sixty percent of people who consulted for febrile syndrome belonged to the county seat. 30% of patients were under 10 years. Fever (98%), myalgia (85%), headache (75%) and arthralgia (65%) were the symptoms reported with more frequency. The largest number of cases occurred in September, 2012. The proposed system of syndromic surveillance will strengthen surveillance considering four components: human, animal, community and environmental by facilitating the opportune identification and treatment of cases of acute febrile illnesses. CONCLUSION The syndromic surveillance system allows to relate comprehensively febrile illnesses with common signs, making the reporting process more efficient.
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Affiliation(s)
- Néstor Yaya-Lancheros
- NY: MDV. Facultad de Medicina, Veterinaria, y de Zootecnia, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Luis J Polo-Terán
- LP: MDV. M. Sc. Salud Pública, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Álvaro A Faccini-Martínez
- AF: M.D, M.Sc. Ph.D en Enfermedades Infecciosas. Comité de Medicina Tropical, Zoonosis y Medicina del Viajero, Asociación Colombiana de Infectología. Bogotá, Colombia.
| | - Marylin Hidalgo-Díaz
- MH: Bacterióloga. M. Sc. Ciencias. Ph.D. en Ciencias Biológicas. Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana. Bogotá, Colombia.
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Dhanoa A, Ngim CF, Yunos NM, Husain SMT, Pong LY, Ismail WFW, Hontz RD, Hassan SS. Contribution of Viral Respiratory Infections to Dengue-Like Illness Presentation at a Community Clinic in Southern Malaysia. Am J Trop Med Hyg 2022; 106:187-191. [PMID: 34583338 PMCID: PMC8733527 DOI: 10.4269/ajtmh.21-0648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023] Open
Abstract
This study explored the contribution of viral respiratory infections (VRIs) in dengue-like illness (DLI) patients and their distinguishing clinicolaboratory parameters. Two hundred DLI patients were prospectively recruited (July 1- October 1, 2019) from a community clinic in Southern Malaysia. Patients ≥ 18 years with acute fever and fulfilling the WHO criteria of probable dengue were recruited. They underwent blood testing: blood counts, rapid dengue tests (nonstructural antigen-1/IgM) and polymerase chain reaction (PCR) for dengue, Zika, chikungunya, and Leptospira. Nasopharyngeal swabs (NPSs) were collected for FilmArray®RP2plus testing. From the 200 NPSs, 58 respiratory viruses (RVs) were detected in 54 patients. Of the 96 dengue-confirmed cases, 86 had dengue mono-infection, and 10 were coinfected with RVs. Of the 104 nondengue, 44 were RV positive and 4 Leptospira positive. Zika and chikungunya virus were not detected. Overall, the etiological diagnosis was confirmed for 72% of patients. Clinicolaboratory parameters were compared between dengue mono-infection and VRI mono-infection. Patients with coinfections were excluded. Multiple logistic regression showed that recent household/neighborhood history of dengue (adjusted odds ratio [aOR]: 5.9, 95% CI = 1.7-20.7), leukopenia (aOR: 12.5, 95% CI = 2.6-61.4) and thrombocytopenia (aOR: 5.5, 95% CI = 1.3-23.0) predicted dengue. Inversely, rhinorrhoea (aOR: 0.1, 95% CI = 0.01-0.3) and cough (aOR: 0.3, 95% CI = 0.1-0.9) favored VRI. Thus, VRIs comprise many infections diagnosed initially as DLIs. Early clinicolaboratory parameters can guide physicians screen patients for further testing.
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Affiliation(s)
- Amreeta Dhanoa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia;,Address correspondence to Amreeta Dhanoa, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia. E-mail:
| | - Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | - Nor’azim Mohd Yunos
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia;,Faculty of Medicine, University of Malaya, Malaysia
| | | | - Lian Yih Pong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | | | | | - Sharifah Syed Hassan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
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Chanie ES, Dagne Z, Jimma MS, Eyayu T, Nebiyu S, Wondifraw EB, GebreEyesus FA, Yemata GA, Melkie A. The effect of timely initiation of complementary feeding and vitamin A supplementation on acute malnutrition among children aged 6-59 months attending Hamusit Health Centre, Northwest Ethiopia, 2021: A cross-sectional study. Heliyon 2021; 7:e08449. [PMID: 34901501 PMCID: PMC8637469 DOI: 10.1016/j.heliyon.2021.e08449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/03/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Acute malnutrition is a nutritional deficiency that results either from inadequate energy or protein intake. It is more prevalent in low- and middle-income countries. Even though efforts have been carried out at the global and national level, the burden is still intolerable and it attracts the attention of the government and researchers. Hence, this study aims to assess the magnitude of acute malnutrition and its associated factors among under-five children who attended Hamusit Health Centre from 1st September to 30th January 2021. MATERIALS AND METHODS This institution-based cross-sectional study was conducted from 1st September to 30th January on 404 randomly selected under-five children who visited the health centre. Samples were selected using a simple random sampling technique, and the data were obtained using a pre-tested standardized questionnaire. For data entry and analysis, Epi-info 7 and SPSS 21 applications were used, respectively. Bivariable and multivariable binary logistic regression were used to identify associated factors at a 95% confidence interval. Significance was considered at p-value<0.05. RESULTS The present research involved a total of 404 children aged 6-59 months. The magnitude of acute malnutrition in this study was 14.4%. Children aged 6-23 months [AOR: 2.92; 95%CI (1.46, 5.85)], vitamin A supplementation [AOR: 0.49; 95%CI (0.25, 0.95)], not timely initiation of complementary feeding [AOR: 2.02; 95%CI (1.06, 3.82)] and children with diarrhea prior to two weeks of the survey [AOR: 2.47; 95% CI (1.28, 4.87)] were significantly associated with acute malnutrition. CONCLUSION A significant number of children aged 6-59 months were affected by acute malnutrition. Younger children, vitamin A supplementation, not timely initiation of complementary feeding, and children with diarrhoea were other factors associated with acute malnutrition.
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Affiliation(s)
| | | | | | - Tahir Eyayu
- Debre Tabor University, Debre Tabor, Ethiopia
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Del Valle-Mendoza J, Palomares-Reyes C, Carrillo-Ng H, Tarazona-Castro Y, Kym S, Aguilar-Luis MA, Del Valle LJ, Aquino-Ortega R, Martins-Luna J, Peña-Tuesta I, Verne E, Silva-Caso W. Leptospirosis in febrile patients with suspected diagnosis of dengue fever. BMC Res Notes 2021; 14:209. [PMID: 34051849 PMCID: PMC8164282 DOI: 10.1186/s13104-021-05627-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Objective This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru. Results A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.
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Affiliation(s)
- Juana Del Valle-Mendoza
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
| | - Carlos Palomares-Reyes
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Hugo Carrillo-Ng
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.,Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Yordi Tarazona-Castro
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Sungmin Kym
- Division of Infectious Disease, Department of Internal Medicine, Chungnam National University School of Medicine , Daejeon, Korea
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Luis J Del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament D'Enginyeria Química, EEBE, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Ronald Aquino-Ortega
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Johanna Martins-Luna
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Isaac Peña-Tuesta
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | | | - Wilmer Silva-Caso
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
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Laoprasopwattana K, Limpitikul W, Geater A. Using Clinical Profiles and Complete Blood Counts to Differentiate Causes of Acute Febrile Illness during the 2009-11 Outbreak of Typhoid and Chikungunya in a Dengue Endemic Area. J Trop Pediatr 2020; 66:504-510. [PMID: 32016406 DOI: 10.1093/tropej/fmaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS After the 2009-11 outbreak of typhoid and chikungunya (CHIK) in Thailand, an effort was made to use complete blood counts and clinical profiles to differentiate these diseases to facilitate earlier specific treatment. METHODS Patients aged 2-15 years having fever on first visit ≤3 days without localizing signs were enrolled retrospectively. Typhoid fever was confirmed by hemoculture, dengue by nonstructural protein-1 or polymerase chain reaction (PCR), and CHIK by PCR. Febrile children with negative results for these infections were classified as other acute febrile illness (AFI). RESULTS Of the 264 cases, 56, 164, 25 and 19 had typhoid fever, dengue viral infection (DVI), CHIK and other AFI, respectively. Arthralgia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value of 0.96, 0.97, 0.80 and 0.99, respectively, to differentiate CHIK from the others. After excluding CHIK by arthralgia, the PPV of the WHO 1997 and 2009 criteria for DVI increased from 0.65 and 0.73 to 0.95 and 0.84, respectively. Children with one of myalgia, headache or leukopenia had sensitivity of 0.84, specificity of 0.76 and PPV of 0.92 to differentiate DVI from typhoid and other AFIs. Patients with one of abdominal pain, diarrhea or body temperature >39.5°C were more likely to have typhoid fever than another AFI with PPV of 0.90. CONCLUSION Using this flow chart can help direct physicians to perform more specific tests to confirm the diagnosis and provide more specific treatment. Nevertheless, clinical follow-up is the most important tool in unknown causes of febrile illness.
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Affiliation(s)
| | - Wannee Limpitikul
- Department of Pediatrics, Songkhla Hospital, Songkhla 90000, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Caraballo E, Poole-Smith BK, Tomashek KM, Torres-Velasquez B, Alvarado LI, Lorenzi OD, Ramos C, Carrión J, Hunsperger E. The detection of anti-dengue virus IgM in urine in participants enrolled in an acute febrile illness study in Puerto Rico. PLoS Negl Trop Dis 2020; 14:e0007971. [PMID: 31995560 PMCID: PMC6988914 DOI: 10.1371/journal.pntd.0007971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue is an important arboviral disease with about 100 million dengue cases per year, of which, ~5% result in severe disease. Clinical differentiation of dengue from other acute febrile illnesses (AFI) is difficult, and diagnostic blood tests are costly. We evaluated the utility of anti-DENV IgM in urine to identify dengue cases among AFI patients enrolled in a clinical study. METHODS Between May 2012-March 2013, 1538 study participants with fever for ≤7 days were enrolled, a medical history was obtained, and serum and urine specimens were collected. Serum was tested for DENV RNA and anti-DENV IgM. Urine was tested for anti-DENV IgM, and its sensitivity and specificity to detect sera laboratory-positive dengue cases were calculated. We evaluated if urine anti-DENV IgM positivity early (≤5 days post-illness onset [DPO]) and late (6-14 DPO) in the clinical course was associated with dengue severity. RESULTS Urine anti-DENV IgM sensitivity and specificity were 47.4% and 98.5%, respectively, when compared with serum anti-DENV IgM ELISA results, and 29.7% and 91.1% when compared with serum rRT-PCR results. There was no correlation between urine anti-DENV IgM positivity and patient sex or pre-existing chronic disease. Early in the clinical course, a significantly higher proportion of those who developed dengue with warning signs had anti-DENV IgM in their urine when compared to those without warning signs (20.4% vs. 4.3%). There was no difference in the proportion with urine anti-DENV IgM positivity between severity groups late in the clinical course. CONCLUSION While detection of urine anti-DENV IgM lacked adequate diagnostic sensitivity, it is a highly specific marker for laboratory-positive dengue, and its presence early in the clinical course may distinguish those with more severe disease. Further assessment of urine anti-DENV IgM by DPO is warranted to determine its utility as an early diagnostic (and possibly prognostic) marker for dengue.
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Affiliation(s)
- Elba Caraballo
- University of Puerto Rico, UPR- Comprehensive Cancer Center(UPRCCC), Division of Cancer Biology, San Juan, Puerto Rico
- * E-mail:
| | | | - Kay M. Tomashek
- National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID), Division of Microbiology and Infectious Diseases (DMID), Office of Clinical Research Resources (OCRR)
| | - Brenda Torres-Velasquez
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | | | - Olga D. Lorenzi
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | - Carmen Ramos
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | - Jessica Carrión
- Centers for Disease Control and Prevention (CDC), Division of Vector Borne Diseases, San Juan, Puerto Rico
| | - Elizabeth Hunsperger
- CDC, Division of Global Health Protection, Epidemiology, Surveillance, Informatics, and Laboratory Branch, CDC-Kenya
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Nyataya J, Maraka M, Lemtudo A, Masakhwe C, Mutai B, Njaanake K, Estambale BB, Nyakoe N, Siangla J, Waitumbi JN. Serological Evidence of Yersiniosis, Tick-Borne Encephalitis, West Nile, Hepatitis E, Crimean-Congo Hemorrhagic Fever, Lyme Borreliosis, and Brucellosis in Febrile Patients Presenting at Diverse Hospitals in Kenya. Vector Borne Zoonotic Dis 2020; 20:348-357. [PMID: 31928511 DOI: 10.1089/vbz.2019.2484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p < 0.0001), brucellosis (OR = 1.84, p = 0.005), CCHF (OR = 4.35, p = 0.001), TBE (OR = 2.78, p < 0.0001), and HEV (OR = 1.94, p = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.
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Affiliation(s)
- Josphat Nyataya
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Moureen Maraka
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Allan Lemtudo
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Clement Masakhwe
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Beth Mutai
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Kariuki Njaanake
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Benson B Estambale
- Division of Research, Innovation and Outreach, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Nancy Nyakoe
- Department of Biochemistry, Cell and Molecular Biology, West African Center for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
| | - Joram Siangla
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - John Njenga Waitumbi
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
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Tillekeratne LG, Bodinayake CK, Simmons R, Nagahawatte A, Devasiri V, Kodikara Arachchi W, Nicholson BP, Park LP, Vanderburg S, Kurukulasooriya R, De Silva AD, Østybe T, Reller ME, Woods CW. Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka. Am J Trop Med Hyg 2019; 100:672-680. [PMID: 30594268 PMCID: PMC6402941 DOI: 10.4269/ajtmh.18-0699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/09/2018] [Indexed: 12/14/2022] Open
Abstract
The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ≥ 1 year of age admitted to a tertiary care hospital in southern Sri Lanka, June 2012-October 2014. We collected epidemiologic/clinical data and a nasal or nasopharyngeal sample that was tested using polymerase chain reaction (Luminex NxTAG, Austin, TX). We determined associations between weather data and respiratory viral activity using the Spearman correlation and assessed respiratory virus seasonality using a Program for Appropriate Technology definition. Bivariable and multivariable regression analyses were conducted to identify features associated with respiratory virus detection. Among 964 patients, median age was 26.2 years (interquartile range 14.6-39.9) and 646 (67.0%) were male. One-fifth (203, 21.1%) had respiratory virus detected: 13.9% influenza, 1.4% human enterovirus/rhinovirus, 1.4% parainfluenza virus, 1.1% respiratory syncytial virus, and 1.1% human metapneumovirus. Patients with respiratory virus identified were younger (median 9.8 versus 27.7 years, P < 0.001) and more likely to have respiratory signs and symptoms. Influenza A and respiratory viral activity peaked in February-June each year. Maximum daily temperature was associated with influenza and respiratory viral activity (P = 0.03 each). Patients with respiratory virus were as likely as others to be prescribed antibiotics (55.2% versus 52.6%, P = 0.51), and none reported prior influenza vaccination. Respiratory viral infection was a common cause of AFI. Improved access to vaccines and respiratory diagnostics may help reduce disease burden and inappropriate antibiotic use.
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Affiliation(s)
- L. Gayani Tillekeratne
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Champica K. Bodinayake
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Ryan Simmons
- Duke Global Health Institute, Durham, North Carolina
| | - Ajith Nagahawatte
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Vasantha Devasiri
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Wasantha Kodikara Arachchi
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - Bradly P. Nicholson
- Duke University, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Lawrence P. Park
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
| | - Sky Vanderburg
- Duke University, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | | | - Aruna Dharshan De Silva
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- General Sir Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Truls Østybe
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Megan E. Reller
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Christopher W. Woods
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
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11
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Febrile seizures: Are they truly benign? Longitudinal analysis of risk factors and future risk of afebrile epileptic seizure based on the national sample cohort in South Korea, 2002–2013. Seizure 2019; 64:77-83. [DOI: 10.1016/j.seizure.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 11/20/2022] Open
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12
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Ricapa-Antay F, Diaz-Melon K, Silva-Caso W, Del Valle LJ, Aguilar-Luis MA, Vasquez-Achaya F, Palomares-Reyes C, Weilg P, Li D, Manrique C, Del Valle-Mendoza J. Molecular detection and clinical characteristics of Bartonella bacilliformis, Leptospira spp., and Rickettsia spp. in the Southeastern Peruvian Amazon basin. BMC Infect Dis 2018; 18:618. [PMID: 30514235 PMCID: PMC6280516 DOI: 10.1186/s12879-018-3541-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/22/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute febrile illness (AFI) represent a significant health challenge in the Peruvian Amazon basin population due to their diverse etiologies and the unavailability of specific on-site diagnostic methods, resulting in underreporting of cases. In Peru, one of the most endemic regions to dengue and leptospirosis is Madre de Dios, a region also endemic to emergent bacterial etiologic agents of AFI, such as bartonellosis and rickettsiosis, whose prevalence is usually underreported. We aimed to molecularly identify the presence of Leptospira spp., Bartonella bacilliformis, and Rickettsia spp. by Polymerase Chain Reaction in serum samples from patients with AFI from Puerto Maldonado-Madre de Dios in Peru. METHODS Serum samples from patients with acute febrile illness were analyzed by real-time PCR for detecting the presence of Bartonella bacilliformis, Leptospira spp. and Rickettsia spp. RESULTS Bartonella bacilliformis was the most prevalent bacteria identified in 21.6% (30/139) of the samples, followed by Leptospira spp. in 11.5% (16/139) and Rickettsia spp. in 6.5% (9/139) of the samples. No co-infections were observed between these bacteria. The most frequent symptoms associated with fever among all groups, were headaches, myalgias, and arthralgias. We found no statistically significant differences in the clinical presentation between patients infected with each bacterium. CONCLUSIONS In a previous study, we shown the presence of dengue, chikungunya, Zika and oropouche virus. We were able to identify these pathogens in 29.5% of all the samples, with chikungunya and OROV as the most frequently found in 9.4 and 8.6% of all the samples, respectively. In this study we show that B. bacilliformis (21.6%), Leptospira spp. (11.5%) and Rickettsia spp. (6.5%) accounted for the main etiologies of AFI in samples from Puerto Maldonado-Madre de Dios, Perú. Our analysis of their clinical presentation, further shows the importance of implementing more sensitive and specific on-site diagnostic tools in the national surveillance programs.This study confirms that the un-specificity of signs and symptoms is not only associated with arboviral infections, but also with the clinical presentation of endemic bacterial infections.
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Affiliation(s)
- Fiorella Ricapa-Antay
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Katia Diaz-Melon
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Wilmer Silva-Caso
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular. Instituto de Investigación Nutricional, Lima, Peru
| | - Luis J Del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament d'Enginyeria Química, EEBE, Universidad Politécnica de Catalunya (UPC), Barcelona Tech, Barcelona, Spain
| | - Miguel Angel Aguilar-Luis
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular. Instituto de Investigación Nutricional, Lima, Peru.,Instituto de Investigación de Enfermedades Infecciosas, Lima, Peru
| | - Fernando Vasquez-Achaya
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular. Instituto de Investigación Nutricional, Lima, Peru
| | - Carlos Palomares-Reyes
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular. Instituto de Investigación Nutricional, Lima, Peru
| | - Pablo Weilg
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Dongmei Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Carlos Manrique
- Dirección Regional de Salud Madre de Dios (DIRESA-Madre de Dios), Puerto Maldonado, Madre de Dios, Peru
| | - Juana Del Valle-Mendoza
- School of Medicine. Faculty of Health Sciences. Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biología Molecular. Instituto de Investigación Nutricional, Lima, Peru.
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13
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Moreira J, Bressan CS, Brasil P, Siqueira AM. Epidemiology of acute febrile illness in Latin America. Clin Microbiol Infect 2018; 24:827-835. [PMID: 29777926 PMCID: PMC7172187 DOI: 10.1016/j.cmi.2018.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
Background The causes of acute febrile illness (AFI) in Latin America are diverse and their complexity increases as the proportion of fever due to malaria decreases, as malaria control measures and new pathogens emerge in the region. In this context, it is important to shed light on the gaps in the epidemiological characteristics and the geographic range for many AFI aetiologies. Objectives To review studies on community-acquired fever aetiology other than malaria in Latin America, and to highlight knowledge gaps and challenges needing further investigation. Sources PubMed from 2012 to April 2018. Content We found 17 eligible studies describing 13 539 patients. The median number of pathogens tested per individual was 3.5 (range 2–17). A causative pathogen could be determined for 6661 (49.2%) individuals. The most frequently reported pathogen during the study periods was dengue virus (DENV) (14 studies), followed by chikungunya virus (nine studies) and Zika virus (seven studies). Among the studies reporting concurrent infections, 296 individuals (2.2%) were found to have co-infections. In-hospital mortality was reported in eight (47%) studies, ranging between 0% and 18%. Implications DENV fever is the febrile illness most frequently reported, reflecting its importance, while chikungunya and zika viruses present increasing trends since their emergence in the region. Studies with systematic and harmonized approaches for detection of multiple pathogens are needed and would probably reveal a higher burden of neglected pathogens such as Rickettsia spp. and arenaviruses. The lack of point-of-care tests and harmonized approach limits the care provided by health professionals and the efficacy of surveillance for AFI in the region.
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Affiliation(s)
- J Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - C S Bressan
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - P Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - A M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
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14
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Bodinayake CK, Tillekeratne LG, Nagahawatte A, Devasiri V, Kodikara Arachchi W, Strouse JJ, Sessions OM, Kurukulasooriya R, Uehara A, Howe S, Ong XM, Tan S, Chow A, Tummalapalli P, De Silva AD, Østbye T, Woods CW, Gubler DJ, Reller ME. Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic. PLoS Negl Trop Dis 2018; 12:e0006258. [PMID: 29425194 PMCID: PMC5823472 DOI: 10.1371/journal.pntd.0006258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/22/2018] [Accepted: 01/22/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. METHODOLOGY/PRINCIPAL FINDINGS The new WHO 2009 classification of dengue divides suspected cases into three categories: dengue without warning signs, dengue with warning signs and severe dengue. We evaluated the WHO 2009 classification vs physicians' subjective clinical diagnosis (gestalt clinical impression) in a large cohort of patients presenting to a tertiary care center in southern Sri Lanka hospitalized with acute febrile illness. We confirmed acute dengue in 388 patients (305 adults ≥ 18 years and 83 children), including 103 primary and 245 secondary cases, of 976 patients prospectively enrolled with AFI. At presentation, both adults and children with acute dengue were more likely than those with other AFI to have leukopenia and thrombocytopenia. Additionally, adults were more likely than those with other AFI to have joint pain, higher temperatures, and absence of crackles on examination whereas children with dengue were more likely than others to have sore throat, fatigue, oliguria, and elevated hematocrit and transaminases. Similarly, presence of joint pain, thrombocytopenia, and absence of cough were independently associated with secondary vs primary dengue in adults whereas no variables were different in children. The 2009 WHO dengue classification was more sensitive than physicians' clinical diagnosis for identification of acute dengue (71.5% vs 67.1%), but was less specific. However, despite the absence of on-site diagnostic confirmation of dengue, clinical diagnosis was more sensitive on discharge (75.2%). The 2009 WHO criteria classified almost 75% as having warning signs, even though only 9 (2.3%) patients had evidence of plasma leakage and 16 (4.1%) had evidence of bleeding. CONCLUSIONS/SIGNIFICANCE In a large cohort with AFI, we identified features predictive of dengue vs other AFI and secondary vs primary dengue in adults versus children. The 2009 WHO dengue classification criteria had high sensitivity but low specificity compared to physicians' gestaldt diagnosis. Large cohort studies will be needed to validate the diagnostic yield of clinical impression and specific features for dengue relative to the 2009 WHO classification criteria.
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Affiliation(s)
| | - L. Gayani Tillekeratne
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Ajith Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Vasantha Devasiri
- Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | - John J. Strouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | | | - Ruvini Kurukulasooriya
- Duke Ruhuna Collaborative Research Center, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Anna Uehara
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Shiqin Howe
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Xin Mei Ong
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Sharon Tan
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Angelia Chow
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | | | | | - Truls Østbye
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Christopher W. Woods
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Hubert-Yeargan Center for Global Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Duane J. Gubler
- Duke Global Health Institute, Durham, NC, United States of America
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| | - Megan E. Reller
- Hubert-Yeargan Center for Global Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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15
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Alva-Urcia C, Aguilar-Luis MA, Palomares-Reyes C, Silva-Caso W, Suarez-Ognio L, Weilg P, Manrique C, Vasquez-Achaya F, del Valle LJ, del Valle-Mendoza J. Emerging and reemerging arboviruses: A new threat in Eastern Peru. PLoS One 2017; 12:e0187897. [PMID: 29136650 PMCID: PMC5685628 DOI: 10.1371/journal.pone.0187897] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 10/27/2017] [Indexed: 12/24/2022] Open
Abstract
Background Arboviral diseases are one of the most common causes of acute febrile illness (AFI) and a significant health problem in South America. In Peru, laboratory etiologic identification of these infections occurs in less than 50% of cases, leading to underdiagnoses of important emerging arboviruses. Aim To assess the prevalence of the Dengue (DENV), Oropouche (OROV), Chikungunya (CHIKV), Mayaro (MAYV) and Zika (ZIKV) viruses in patients with acute febrile illness from Puerto Maldonado (Peru). Methodology Serum samples were obtained from patients with AFI during January 2016 to March 2016. A total of 139 specimens were analyzed for the presence of DENV, OROV, CHIKV, MAYV, and ZIKV using polymerase chain reaction (PCR). Results CHIKV in 9.4% and OROV in 8.6% were the most prevalent arboviruses, followed by DENV and ZIKV, with a prevalence of 6.5% and 5%, respectively. Among all patients, the most common symptoms accompanying fever were headaches 79.9%, muscle pain 65.5% and joint pain 63.3%. Conclusions During this short 3-month period, 4 arboviruses were detected by PCR, CHIKV and OROV being the most common arboviruses in Puerto Maldonado (Peru). Thus, it is crucial to include OROV detection in the national health surveillance. Furthermore, the etiologic clinical diagnosis of arboviral infections is not possible due to the low specificity of symptoms; therefore an increase of cases confirmed by molecular diagnostic methods will enhance arboviral surveillance in Peru.
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Affiliation(s)
- Carlos Alva-Urcia
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
- Laboratorio de Biología Molecular, Instituto de Investigación Nutricional (IIN), Lima, Perú
- * E-mail: (JdVM); (MAAL)
| | - Carlos Palomares-Reyes
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Wilmer Silva-Caso
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
- Laboratorio de Biología Molecular, Instituto de Investigación Nutricional (IIN), Lima, Perú
| | - Luis Suarez-Ognio
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Pablo Weilg
- Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Carlos Manrique
- Dirección Regional de Salud Madre de Dios (DIRESA-Madre de Dios), Madre de Dios, Peru
| | - Fernando Vasquez-Achaya
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Luis J. del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament d’Enginyeria Quıímica, EEBE, Universidad Politécnica de Catalunya (UPC), Barcelona Tech, Barcelona, Spain
| | - Juana del Valle-Mendoza
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
- Laboratorio de Biología Molecular, Instituto de Investigación Nutricional (IIN), Lima, Perú
- * E-mail: (JdVM); (MAAL)
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16
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Li GH, Ning ZJ, Liu YM, Li XH. Neurological Manifestations of Dengue Infection. Front Cell Infect Microbiol 2017; 7:449. [PMID: 29119088 PMCID: PMC5660970 DOI: 10.3389/fcimb.2017.00449] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS), peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.
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Affiliation(s)
- Guo-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Zhi-Jie Ning
- Jinan Infectious Diseases Hospital, Jinan, China
| | - Yi-Ming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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17
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Braga JU, Bressan C, Dalvi APR, Calvet GA, Daumas RP, Rodrigues N, Wakimoto M, Nogueira RMR, Nielsen-Saines K, Brito C, Bispo de Filippis AM, Brasil P. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics. PLoS One 2017. [PMID: 28650987 PMCID: PMC5484469 DOI: 10.1371/journal.pone.0179725] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. Methodology We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. Results and discussion Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096. Conclusions In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.
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Affiliation(s)
- José Ueleres Braga
- Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Clarisse Bressan
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Guilherme Amaral Calvet
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Regina Paiva Daumas
- Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Nadia Rodrigues
- Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Mayumi Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rita Maria Ribeiro Nogueira
- Laboratorio de Referencia de Flavivirus, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Carlos Brito
- Departmento de Clinica Medica, Universidade Federal de Pernambuco, Recife, Brazil
| | - Ana Maria Bispo de Filippis
- Laboratorio de Referencia de Flavivirus, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
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Cui L, Fang J, Ooi EE, Lee YH. Serial Metabolome Changes in a Prospective Cohort of Subjects with Influenza Viral Infection and Comparison with Dengue Fever. J Proteome Res 2017; 16:2614-2622. [DOI: 10.1021/acs.jproteome.7b00173] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Liang Cui
- Translational
‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, Singapore 229899
- Infectious
Diseases Interdisciplinary Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602
| | - Jinling Fang
- Infectious
Diseases Interdisciplinary Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602
| | - Eng Eong Ooi
- Infectious
Diseases Interdisciplinary Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602
- Emerging
Infectious Diseases, Duke-NUS Medical School, Singapore 169857
| | - Yie Hou Lee
- Translational
‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, Singapore 229899
- Infectious
Diseases Interdisciplinary Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602
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Epidemiological Characteristics of Dengue Disease in Latin America and in the Caribbean: A Systematic Review of the Literature. J Trop Med 2017; 2017:8045435. [PMID: 28392806 PMCID: PMC5368385 DOI: 10.1155/2017/8045435] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/31/2017] [Accepted: 02/21/2017] [Indexed: 12/03/2022] Open
Abstract
Dengue, an important mosquito-borne virus transmitted mainly by Aedes aegypti, is a major public health issue in Latin America and the Caribbean. National epidemiological surveillance systems, usually based on passive detection of symptomatic cases, while underestimating the true burden of dengue disease, can provide valuable insight into disease trends and excess reporting and potential outbreaks. We carried out a systematic review of the literature to characterize the recent epidemiology of dengue disease in Latin America and the English-speaking and Hispanic Caribbean Islands. We identified 530 articles, 60 of which met criteria for inclusion. In general, dengue seropositivity across the region was high and increased with age. All four virus serotypes were reported to circulate in the region. These observations varied considerably between and within countries and over time, potentially due to climatic factors (temperature, rainfall, and relative humidity) and their effect on mosquito densities and differences in socioeconomic factors. This review provides important insight into the major epidemiological characteristics of dengue in distinct regions of Latin America and the Caribbean, allowing gaps in current knowledge and future research needs to be identified.
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Jones AH, Ampofo W, Akuffo R, Doman B, Duplessis C, Amankwa JA, Sarpong C, Sagoe K, Agbenohevi P, Puplampu N, Armah G, Koram KA, Nyarko EO, Bel-Nono S, Dueger EL. Sentinel surveillance for influenza among severe acute respiratory infection and acute febrile illness inpatients at three hospitals in Ghana. Influenza Other Respir Viruses 2016; 10:367-74. [PMID: 27239956 PMCID: PMC4947945 DOI: 10.1111/irv.12397] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 12/04/2022] Open
Abstract
Background Influenza epidemiology in Africa is generally not well understood. Using syndrome definitions to screen patients for laboratory confirmation of infection is an established means to effectively conduct influenza surveillance. Methods To compare influenza‐related epidemiologic data, from October 2010 through March 2013, we enrolled hospitalized severe acute respiratory infection (SARI; fever with respiratory symptoms) and acute febrile illness (AFI; fever without respiratory or other localizing symptoms) patients from three referral hospitals in Ghana. Demographic and epidemiologic data were obtained from enrolled patients after which nasopharyngeal and oropharyngeal swabs were collected, and processed by molecular methods for the presence of influenza viruses. Results Of 730 SARI patients, 59 (8%) were influenza positive; of 543 AFI patients, 34 (6%) were positive for influenza. Both SARI and AFI surveillance yielded influenza A(H3N2) (3% versus 1%), A(H1N1)pdm09 (2% versus 1%), and influenza B (3% versus 4%) in similar proportions. Data from both syndromes show year‐round influenza transmission but with increased caseloads associated with the rainy seasons. Conclusions As an appreciable percentage of influenza cases (37%) presented without defined respiratory symptoms, and thus met the AFI but not the SARI definition, it is important to consider broader screening criteria (i.e., AFI) to identify all laboratory‐confirmed influenza. The identified influenza transmission seasonality has important implications for the timing of related public health interventions.
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Affiliation(s)
- Alexander H Jones
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, National Influenza Center, Accra, Ghana
| | - Richard Akuffo
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3 Ghana Detachment, Accra, Ghana
| | - Brooke Doman
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3 Ghana Detachment, Accra, Ghana
| | | | | | | | - Ken Sagoe
- Tamale Teaching Hospital, Tamale, Ghana
| | | | - Naiki Puplampu
- U.S. Naval Medical Research Unit No. 3 Ghana Detachment, Accra, Ghana
| | - George Armah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | - Erica L Dueger
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA.,U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
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21
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Bell SA. Climate change … are we prepared and ready? Int Emerg Nurs 2016; 26:1-2. [PMID: 27009977 DOI: 10.1016/j.ienj.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sue Anne Bell
- University of Michigan School of Nursing, 400 North Ingalls, Rm 3340, Ann Arbor, MI 48109.
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22
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Chacon R, Clara AW, Jara J, Armero J, Lozano C, El Omeiri N, Widdowson MA, Azziz-Baumgartner E. Influenza Illness among Case-Patients Hospitalized for Suspected Dengue, El Salvador, 2012. PLoS One 2015; 10:e0140890. [PMID: 26485296 PMCID: PMC4618691 DOI: 10.1371/journal.pone.0140890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
We estimate the proportion of patients hospitalized for suspected dengue that tested positive for influenza virus in El Salvador during the 2012 influenza season. We tested specimens from 321 hospitalized patients: 198 patients with SARI and 123 patients with suspected dengue. Among 121 hospitalized suspected dengue (two co-infected excluded) patients, 28% tested positive for dengue and 19% positive for influenza; among 35 with suspected dengue and respiratory symptoms, 14% were positive for dengue and 39% positive for influenza. One percent presented co-infection between influenza and dengue. Clinicians should consider the diagnosis of influenza among patients with suspected dengue during the influenza season.
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Affiliation(s)
- Rafael Chacon
- Influenza Unit, University of the Valley of Guatemala, Guatemala City, Guatemala
- * E-mail:
| | - Alexey Wilfrido Clara
- Influenza Program, Centers for Disease Control and Prevention for Central American Region, Guatemala City, Guatemala
| | - Jorge Jara
- Influenza Unit, University of the Valley of Guatemala, Guatemala City, Guatemala
| | - Julio Armero
- Health Surveillance Directorate, Ministry of Health of El Salvador, San Salvador, El Salvador
| | - Celina Lozano
- National Influenza Center, Ministry of Health of El Salvador, San Salvador, El Salvador
| | - Nathalie El Omeiri
- Influenza Unit, Training Programs in Epidemiology and Public Health Interventions Network, Guatemala City, Guatemala
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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23
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Noyd DH, Sharp TM. Recent Advances in Dengue: Relevance to Puerto Rico. PUERTO RICO HEALTH SCIENCES JOURNAL 2015; 34:65-70. [PMID: 26061055 PMCID: PMC4587385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Dengue represents an increasingly important public health challenge in Puerto Rico, with recent epidemics in 2007, 2010, and 2012-2013. Although recent advances in dengue vaccine development offer hope for primary prevention, the role of health professionals in the diagnosis and management of dengue patients is paramount. Case definitions for dengue, dengue with warning signs, and severe dengue provide a framework to guide clinical decision-making. Furthermore, the differentiation between dengue and other acute febrile illnesses, such as leptospirosis and chikungunya, is necessary for the appropriate diagnosis and management of cases. An understanding of dengue epidemiology and surveillance in Puerto Rico provides context for clinicians in epidemic and non-epidemic periods. This review aims to improve health professionals' ability to diagnose dengue, and as highlight the relevance of recent advances in dengue prevention and management in Puerto Rico.
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Affiliation(s)
- David H. Noyd
- Oregon Health & Science University, Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
| | - Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
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Osorio L, Uribe M, Ardila GI, Orejuela Y, Velasco M, Bonelo A, Parra B. The use of rapid dengue diagnostic tests in a routine clinical setting in a dengue-endemic area of Colombia. Mem Inst Oswaldo Cruz 2015; 110:510-6. [PMID: 25993399 PMCID: PMC4501415 DOI: 10.1590/0074-02760140359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/01/2015] [Indexed: 12/03/2022] Open
Abstract
There is insufficient evidence of the usefulness of dengue diagnostic tests under
routine conditions. We sought to analyse how physicians are using dengue diagnostics
to inform research and development. Subjects attending 14 health institutions in an
endemic area of Colombia with either a clinical diagnosis of dengue or for whom a
dengue test was ordered were included in the study. Patterns of test-use are
described herein. Factors associated with the ordering of dengue diagnostic tests
were identified using contingency tables, nonparametric tests and logistic
regression. A total of 778 subjects were diagnosed with dengue by the treating
physician, of whom 386 (49.5%) were tested for dengue. Another 491 dengue tests were
ordered in subjects whose primary diagnosis was not dengue. Severe dengue
classification [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5], emergency
consultation (OR 1.9; 95% CI 1.4-2.5) and month of the year (OR 3.1; 95% CI 1.7-5.5)
were independently associated with ordering of dengue tests. Dengue tests were used
both to rule in and rule out diagnosis. The latter use is not justified by the
sensitivity of current rapid dengue diagnostic tests. Ordering of dengue tests appear
to depend on a combination of factors, including physician and institutional
preferences, as well as other patient and epidemiological factors.
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Affiliation(s)
- Lyda Osorio
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia
| | - Marcela Uribe
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia
| | - Gloria Ines Ardila
- Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Yaneth Orejuela
- Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Margarita Velasco
- Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Anilza Bonelo
- Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia
| | - Beatriz Parra
- Departamento de Microbiología, Universidad del Valle, Cali, Colombia
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Frequency and clinical manifestations of dengue in urban medellin, Colombia. J Trop Med 2014; 2014:872608. [PMID: 24987421 PMCID: PMC4060062 DOI: 10.1155/2014/872608] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/17/2022] Open
Abstract
A dengue fever surveillance study was conducted at three medical facilities located in the low-income district of San Javier in Medellin, Colombia. During March 2008 to 2009, 781 patients with fever regardless of chief complaint were recruited for acute dengue virus infection testing. Of the 781 tested, 73 (9.3%) were positive for dengue infection. Serotypes DENV-2 (77%) and -3 (23%) were detected by PCR. One patient met the diagnostic criteria for dengue hemorrhagic fever. Only 3 out of 73 (4.1%) febrile subjects testing positive for dengue infection were diagnosed with dengue fever by the treating physician. This study confirms dengue virus as an important cause of acute febrile illness in Medellin, Colombia, but it is difficult to diagnose without dengue diagnostic testing.
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