Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015.
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 multi...
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2017-09-01
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| Series: | PLoS Neglected Tropical Diseases |
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| author | 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 |
| author_facet | 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 |
| author_sort | Kay M Tomashek |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-068e202edd6b45cfa7af8fd95d4358c2 |
| institution | DOAJ |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2017-09-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-068e202edd6b45cfa7af8fd95d4358c22025-08-20T03:04:58ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352017-09-01119e000585910.1371/journal.pntd.0005859Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015.Kay M TomashekOlga D LorenziDoris A Andújar-PérezBrenda C Torres-VelásquezElizabeth A HunspergerJorge Luis Munoz-JordanJanice Perez-PadillaAidsa RiveraGladys E Gonzalez-ZenoTyler M SharpRenee L GallowayMindy Glass ElrodDemetrius L MathisM Steven ObersteW Allan NixElizabeth HendersonJennifer McQuistonJoseph SingletonCecilia KatoCarlos García GubernWilliam Santiago-RiveraJesús Cruz-CorreaRobert Muns-SosaJuan D Ortiz-RiveraGerson JiménezIvonne E GalarzaKalanthe HoriuchiHarold S MargolisLuisa I AlvaradoIdentifying 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.https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0005859&type=printable |
| spellingShingle | 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 Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015. PLoS Neglected Tropical Diseases |
| title | Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015. |
| title_full | Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015. |
| title_fullStr | Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015. |
| title_full_unstemmed | Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015. |
| title_short | Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015. |
| title_sort | clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness puerto rico 2012 2015 |
| url | https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0005859&type=printable |
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