Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults.
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 compare...
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doaj-0cb66d83a4284eec8f27667101ec73342020-11-25T01:01:26ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352012-01-0169e178610.1371/journal.pntd.0001786Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults.Vernon J LeeAngela ChowXiaohui ZhengLuis R CarrascoAlex R CookDavid C LyeLee-Ching NgYee-Sin LeoBACKGROUND: 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.http://europepmc.org/articles/PMC3459852?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Vernon J Lee Angela Chow Xiaohui Zheng Luis R Carrasco Alex R Cook David C Lye Lee-Ching Ng Yee-Sin Leo |
spellingShingle |
Vernon J Lee Angela Chow Xiaohui Zheng Luis R Carrasco Alex R Cook David C Lye Lee-Ching Ng Yee-Sin Leo Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Neglected Tropical Diseases |
author_facet |
Vernon J Lee Angela Chow Xiaohui Zheng Luis R Carrasco Alex R Cook David C Lye Lee-Ching Ng Yee-Sin Leo |
author_sort |
Vernon J Lee |
title |
Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. |
title_short |
Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. |
title_full |
Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. |
title_fullStr |
Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. |
title_full_unstemmed |
Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. |
title_sort |
simple clinical and laboratory predictors of chikungunya versus dengue infections in adults. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS Neglected Tropical Diseases |
issn |
1935-2727 1935-2735 |
publishDate |
2012-01-01 |
description |
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. |
url |
http://europepmc.org/articles/PMC3459852?pdf=render |
work_keys_str_mv |
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