| Autor: |
Tomashek KM; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Lorenzi OD; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Andújar-Pérez DA; Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America., Torres-Velásquez BC; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Hunsperger EA; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Munoz-Jordan JL; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Perez-Padilla J; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Rivera A; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Gonzalez-Zeno GE; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Sharp TM; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Galloway RL; Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America., Glass Elrod M; Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America., Mathis DL; Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America., Oberste MS; Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America., Nix WA; Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America., Henderson E; Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America., McQuiston J; Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America., Singleton J; Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America., Kato C; Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America., García Gubern C; Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America., Santiago-Rivera W; Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America., Cruz-Correa J; Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America., Muns-Sosa R; Saint Luke's Episcopal Hospital, Guayama, Puerto Rico, United States of America., Ortiz-Rivera JD; Saint Luke's Episcopal Hospital, Guayama, Puerto Rico, United States of America., Jiménez G; Saint Luke's Episcopal Hospital, Guayama, Puerto Rico, United States of America., Galarza IE; Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America., Horiuchi K; Office of the Director, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado, United States of America., Margolis HS; Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America., Alvarado LI; Ponce Health Sciences University/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America. |
| Abstrakt: |
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. |
