Estudo das Características das principais Doenças Febris Agudas atendidas em serviço de referência do Instituto Nacional de Infectologia Evandro Chagas/FIOCRUZ

Acute Febrile Diseases are unspecific as to their presentation. In cities endemic for Dengue Fever its diagnosis is overestimated. Being aware of signs and symptoms of infectious diseases, as well as how frequently they occur, may contribute to the construction of diagnostic models based on early clinical signs. This study was performed in patients over 12 years old, treated at IPEC in the period 2004-2008, reporting fever of up to ten days at the first appointment. The aim is to describe the prevalence of major Acute Febrile Diseases diagnosed. One third of the patients was febrile travelers, mostly from other cities in Brazil but also from international departures. Dengue Fever (DF) was the main DFA diagnosed (n = 211) followed by Malaria (n = 31). Other Acute Viral Diseases were Rubella (n = 11), Parvovirus (4), HIV seroconversion (1), Varicella (1), CMV (3), viral hepatitis (7), viral meningitis (1), EBV infection (2). Among other etiologies stands out cases of Leptospirosis (7), Rickettsiosis (5). A significant portion of patients had no confirmed laboratory diagnosis (n = 224). Of that group, 116 (51.8%) received presumptive diagnosis of Dengue, but had no laboratory confirmation. The signs and symptoms more prevalent in patients where Dengue Fever was confirmed (100%), headache (89.1%), prostration (97.6%), myalgia (91.5%), rash (76.6%) anorexia (82.5%) and altered mouth taste (69.1%). The presence of chills, jaundice, splenomegaly and hepatomegaly was significantly higher in patients diagnosed with Malaria. There was no significant difference between the frequency of hemorrhagic manifestations, headache, or the average number of platelets between Dengue and Malaria The presence of cough, runny nose, palpable lymphadenopathy, and jaundice was significantly higher in patients with other Acute Viral Diseases when compared to those with Dengue wich in turn, had lower average total leukocytes and platelets. Among patients without laboratory diagnosis completed coryza, jaundice and splenomegaly were significantly more frequent than in the group with Dengue. More than a half of patients with clinical diagnosis of Dengue has confirmed this etiology and positive predictive value of clinical suspicion was 58%. The negative predictive value found was 87%. In the epidemic period, these values were 69 and 85% respectively. The presumptive diagnosis (initial clinical hypothesis) of Dengue Fever has low positive predictive value, so the laboratory diagnosis should be useful to differentiate it from other causes of acute fever. The exam of Malaria must be requested in any febrile traveler from an endemic area for this disease, because clinical or laboratory findings are not specific enough to differentiate safely between the two diseases.