3 years ago

Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012–2015

Juan D. Ortiz-Rivera, Kay M. Tomashek, Jesús Cruz-Correa, Luisa I. Alvarado, Demetrius L. Mathis, Aidsa Rivera, W. Allan Nix, Gerson Jiménez, Joseph Singleton, Brenda C. Torres-Velásquez, Jennifer McQuiston, Robert Muns-Sosa, William Santiago-Rivera, Ivonne E. Galarza, Jorge Luis Munoz-Jordan, Elizabeth A. Hunsperger, Carlos García Gubern, Tyler M. Sharp, Mindy Glass Elrod, Doris A. Andújar-Pérez, Olga D. Lorenzi, Cecilia Kato, Gladys E. Gonzalez-Zeno, Elizabeth Henderson, Kalanthe Horiuchi, Janice Perez-Padilla, Harold S. Margolis, M. Steven Oberste, Renee L. Galloway

by Kay M. Tomashek, Olga D. Lorenzi, Doris A. Andújar-Pérez, Brenda C. Torres-Velásquez, Elizabeth A. Hunsperger, Jorge Luis Munoz-Jordan, Janice Perez-Padilla, Aidsa Rivera, Gladys E. Gonzalez-Zeno, Tyler M. Sharp, Renee L. Galloway, Mindy Glass Elrod, Demetrius L. Mathis, M. Steven Oberste, W. Allan Nix, Elizabeth Henderson, Jennifer McQuiston, Joseph Singleton, Cecilia Kato, Carlos García Gubern, William Santiago-Rivera, Jesús Cruz-Correa, Robert Muns-Sosa, Juan D. Ortiz-Rivera, Gerson Jiménez, Ivonne E. Galarza, Kalanthe Horiuchi, Harold S. Margolis, Luisa I. Alvarado

Identifying etiologies of acute febrile illnesses (AFI) is challenging due to non-specific presentation and limited availability of diagnostics. Prospective AFI studies provide a methodology to describe the syndrome by age and etiology, findings that can be used to develop case definitions and multiplexed diagnostics to optimize management. We conducted a 3-year prospective AFI study in Puerto Rico. Patients with fever ≤7 days were offered enrollment, and clinical data and specimens were collected at enrollment and upon discharge or follow-up. Blood and oro-nasopharyngeal specimens were tested by RT-PCR and immunodiagnostic methods for infection with dengue viruses (DENV) 1–4, chikungunya virus (CHIKV), influenza A and B viruses (FLU A/B), 12 other respiratory viruses (ORV), enterovirus, Leptospira spp., and Burkholderia pseudomallei. Clinical presentation and laboratory findings of participants infected with DENV were compared to those infected with CHIKV, FLU A/B, and ORV. Clinical predictors of laboratory-positive dengue compared to all other AFI etiologies were determined by age and day post-illness onset (DPO) at presentation. Of 8,996 participants enrolled from May 7, 2012 through May 6, 2015, more than half (54.8%, 4,930) had a pathogen detected. Pathogens most frequently detected were CHIKV (1,635, 18.2%), FLU A/B (1,074, 11.9%), DENV 1–4 (970, 10.8%), and ORV (904, 10.3%). Participants with DENV infection presented later and a higher proportion were hospitalized than those with other diagnoses (46.7% versus 27.3% with ORV, 18.8% with FLU A/B, and 11.2% with CHIKV). Predictors of dengue in participants presenting <3 DPO included leukopenia, thrombocytopenia, headache, eye pain, nausea, and dizziness, while negative predictors were irritability and rhinorrhea. Predictors of dengue in participants presenting 3–5 DPO were leukopenia, thrombocytopenia, facial/neck erythema, nausea, eye pain, signs of poor circulation, and diarrhea; presence of rhinorrhea, cough, and red conjunctiva predicted non-dengue AFI. By enrolling febrile patients at clinical presentation, we identified unbiased predictors of laboratory-positive dengue as compared to other common causes of AFI. These findings can be used to assist in early identification of dengue patients, as well as direct anticipatory guidance and timely initiation of correct clinical management.

Publisher URL: http://journals.plos.org/plosntds/article

DOI: 10.1371/journal.pntd.0005859

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.