Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study.

Autor:	Rosenberger KD; Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany; Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany., Phung Khanh L; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam., Tobian F; Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany., Chanpheaktra N; Angkor Hospital for Children, Siem Reap, Cambodia., Kumar V; Angkor Hospital for Children, Siem Reap, Cambodia; East Tennessee State University Quillen College of Medicine, Johnson City, TN, USA., Lum LCS; University of Malaya, Medical Centre, Kuala Lumpur, Malaysia., Sathar J; Ampang Hospital, Ministry of Health, Kuala Lumpur, Malaysia., Pleités Sandoval E; Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador., Marón GM; Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador; St Jude Children's Research Hospital, Memphis, TN, USA., Laksono IS; Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Child Health, Dr Sardjito General Hospital, Yogyakarta, Indonesia., Mahendradhata Y; Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia., Sarker M; Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany; James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh., Rahman R; Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh., Caprara A; Universidade Estadual Do Ceará, Fortaleza, Brazil., Souza Benevides B; Universidade Estadual Do Ceará, Fortaleza, Brazil; Centro Universitário Christus-Unichristus, Fortaleza, Brazil; Centro Universitário Fametro-Unifametro, Fortaleza, Brazil., Marques ETA; Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil; Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA., Magalhaes T; Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil; Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Department of Entomology, Texas A&M University, College Station, TX, USA., Brasil P; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Amaral Calvet G; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Tami A; Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela; Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Bethencourt SE; Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela., Dong Thi Hoai T; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam., Nguyen Tan Thanh K; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam., Tran Van N; Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam., Nguyen Tran N; Children's Hospital Number 2, Ho Chi Minh City, Viet Nam., Do Chau V; Children's Hospital Number 2, Ho Chi Minh City, Viet Nam., Yacoub S; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK., Nguyen Van K; National Hospital for Tropical Diseases, Hanoi, Viet Nam., Guzmán MG; Institute of Tropical Medicine 'Pedro Kouri' (IPK), Havana, Cuba., Martinez PA; Institute of Tropical Medicine 'Pedro Kouri' (IPK), Havana, Cuba., Nguyen Than Ha Q; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam., Simmons CP; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Institute of Vector-borne Disease, Monash University, Melbourne, VIC, Australia., Wills BA; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK., Geskus RB; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK., Jaenisch T; Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany; Center for Global Health, Colorado School of Public Health, Aurora, CO, USA; Paediatric Infectious Diseases, Colorado School of Medicine, Aurora, CO, USA. Electronic address: thomas.jaenisch@uni-heidelberg.de.
Jazyk:	angličtina
Zdroj:	The Lancet. Global health [Lancet Glob Health] 2023 Mar; Vol. 11 (3), pp. e361-e372.
DOI:	10.1016/S2214-109X(22)00514-9
Abstrakt:	Background: Improvements in the early diagnosis of dengue are urgently needed, especially in resource-limited settings where the distinction between dengue and other febrile illnesses is crucial for patient management. Methods: In this prospective, observational study (IDAMS), we included patients aged 5 years and older with undifferentiated fever at presentation from 26 outpatient facilities in eight countries (Bangladesh, Brazil, Cambodia, El Salvador, Indonesia, Malaysia, Venezuela, and Viet Nam). We used multivariable logistic regression to investigate the association between clinical symptoms and laboratory tests with dengue versus other febrile illnesses between day 2 and day 5 after onset of fever (ie, illness days). We built a set of candidate regression models including clinical and laboratory variables to reflect the need of a comprehensive versus parsimonious approach. We assessed performance of these models via standard measures of diagnostic values. Findings: Between Oct 18, 2011, and Aug 4, 2016, we recruited 7428 patients, of whom 2694 (36%) were diagnosed with laboratory-confirmed dengue and 2495 (34%) with (non-dengue) other febrile illnesses and met inclusion criteria, and were included in the analysis. 2703 (52%) of 5189 included patients were younger than 15 years, 2486 (48%) were aged 15 years or older, 2179 (42%) were female and 3010 (58%) were male. Platelet count, white blood cell count, and the change in these variables from the previous day of illness had a strong association with dengue. Cough and rhinitis had strong associations with other febrile illnesses, whereas bleeding, anorexia, and skin flush were generally associated with dengue. Model performance increased between day 2 and 5 of illness. The comprehensive model (18 clinical and laboratory predictors) had sensitivities of 0·80 to 0·87 and specificities of 0·80 to 0·91, whereas the parsimonious model (eight clinical and laboratory predictors) had sensitivities of 0·80 to 0·88 and specificities of 0·81 to 0·89. A model that includes laboratory markers that are easy to measure (eg, platelet count or white blood cell count) outperformed the models based on clinical variables only. Interpretation: Our results confirm the important role of platelet and white blood cell counts in diagnosing dengue, and the importance of serial measurements over subsequent days. We successfully quantified the performance of clinical and laboratory markers covering the early period of dengue. Resulting algorithms performed better than published schemes for distinction of dengue from other febrile illnesses, and take into account the dynamic changes over time. Our results provide crucial information needed for the update of guidelines, including the Integrated Management of Childhood Illness handbook. Funding: EU's Seventh Framework Programme. Translations: For the Bangla, Bahasa Indonesia, Portuguese, Khmer, Spanish and Vietnamese translations of the abstract see Supplementary Materials section. Competing Interests: Declaration of interests TJ reports personal fees from the Roche Severe Dengue Advisory Board, Takeda Pharmaceutical Company, Merck Pharmaceuticals, and Emergent Biosolutions, as a member of advisory boards, outside the submitted work. BAW reports personal fees from Takeda Pharmaceutical Company and from the Roche Severe Dengue Advisory Board, outside the submitted work. SY reports personal fees from Roche, outside the submitted work. All other authors declare no competing interests. (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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