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Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults.
PLoS Negl Trop Dis. 2012; 6(9):e1786.PN

Abstract

BACKGROUND

Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF), is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making.

METHODS

We compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR) with 917 dengue RT-PCR-positive adult patients (including 55 with DHF). We compared dengue fever (DF), DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables.

FINDINGS

At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF), nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets <118 × 10(9)/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets <100 × 10(9)/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable.

INTERPRETATION

There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management.

Authors+Show Affiliations

Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore. vernonljm@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23029573

Citation

Lee, Vernon J., et al. "Simple Clinical and Laboratory Predictors of Chikungunya Versus Dengue Infections in Adults." PLoS Neglected Tropical Diseases, vol. 6, no. 9, 2012, pp. e1786.
Lee VJ, Chow A, Zheng X, et al. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Negl Trop Dis. 2012;6(9):e1786.
Lee, V. J., Chow, A., Zheng, X., Carrasco, L. R., Cook, A. R., Lye, D. C., Ng, L. C., & Leo, Y. S. (2012). Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Neglected Tropical Diseases, 6(9), e1786. https://doi.org/10.1371/journal.pntd.0001786
Lee VJ, et al. Simple Clinical and Laboratory Predictors of Chikungunya Versus Dengue Infections in Adults. PLoS Negl Trop Dis. 2012;6(9):e1786. PubMed PMID: 23029573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. AU - Lee,Vernon J, AU - Chow,Angela, AU - Zheng,Xiaohui, AU - Carrasco,Luis R, AU - Cook,Alex R, AU - Lye,David C, AU - Ng,Lee-Ching, AU - Leo,Yee-Sin, Y1 - 2012/09/27/ PY - 2012/03/30/received PY - 2012/07/05/accepted PY - 2012/10/3/entrez PY - 2012/10/3/pubmed PY - 2013/1/29/medline SP - e1786 EP - e1786 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 6 IS - 9 N2 - BACKGROUND: Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF), is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making. METHODS: We compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR) with 917 dengue RT-PCR-positive adult patients (including 55 with DHF). We compared dengue fever (DF), DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables. FINDINGS: At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF), nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets <118 × 10(9)/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets <100 × 10(9)/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable. INTERPRETATION: There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/23029573/full_citation L2 - http://dx.plos.org/10.1371/journal.pntd.0001786 DB - PRIME DP - Unbound Medicine ER -