Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia
Matthew R. KasperPatrick J. BlairSok TouchButh SokhalChadwick Y. YasudaMaya WilliamsAllen L. RichardsTimothy BurgessThomas F. WierzbaShannon D. Putnam
113
Citation
32
Reference
10
Related Paper
Citation Trend
Abstract:
The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations.Keywords:
Etiology
Influenza-like illness
Background: Dengue is the most rapidly spreading mosquito borne viral disease in the world. There is an increase in incidence of dengue in adult population in South Asian countries in recent years. Objective: To study the pattern of dengue in adults and the significance of total leukocyte count in assessing the clinical course of dengue. Materials & Methods: All adult patients admitted with fever and features suggestive of dengue infection were included in the study. Serological testing for dengue virus specific antigen and antibody was done for the diagnosis of dengue fever. The demographic data, clinical features, hematological and biochemical parameters were collected. The World Health Organization classification and case definitions 2009 was used to categorize the dengue patients. The variable pattern of the disease and the importance of total leukocyte count in the monitoring of the natural course of the illness were studied. Results: Of the total 169 patients admitted with suspected dengue infection, 74 were diagnosed with dengue serologically. Of these 74 patients, 31(41.9%) had primary dengue infection and 43 (58.1%) had secondary dengue infection. Number of patients who had probable dengue, dengue +warning signs and severe dengue were 39 (52.7%), 24 (32.4%) and 11 (14.9%) respectively. Petechiae were seen in 22 (29.7%) patients, tender hepatomegaly in 18 (24.3%). A very low total leukocyte count and a very low
Cite
Citations (0)
Background : Dengue is one of the most prevalent vector borne diseases worldwide. Dengue fever presents with wide clinical spectrum ranging from self limiting infection to severe dengue. Aim: Present study is done to correlate a novel indicator 'Dengue Score' with the severity of dengue. Methods: A 2 year cross-sectional study was conducted among patients presenting with Dengue fever at BMCRI, Bangalore. Results : A total of 55 patients were included in the study. Mean age in the study was 42 years. Out of 55 patients, 33(60%) were males and 22(40%) were females. 36 had dengue fever without warning signs, 13 had Dengue fever with warning signs and 6 had severe dengue. Dengue score of 2 was associated with Hemoconcentration and severe thrombocytopenia. Dengue score of 3 or more was associated with Severe Dengue. Conclusion: Present study showed that Higher Dengue Score is associated with increased risk of plasma leakage and Severe Dengue. It is a simple scoring system, which uses laboratory parameters that are routinely measured in clinical practice
Warning signs
Cite
Citations (0)
Introduction: The latest revised version of the World Health Organization’s dengue classification was released in 2009. A handful of studies have taken initiatives to evaluate the old and revised guidelines to determine early signs and symptoms of severe dengue. This retrospective study aimed to compare the classification of dengue using both the 1997 and 2009 guidelines in a selected cohort of dengue patients from Peninsular Malaysia between 2008 and 2012. Methodology: Adult dengue patients were recruited from tertiary hospitals in two different states, Selangor and Kelantan, in Peninsular Malaysia. Their clinical manifestations were assessed. Results: A total of 281 confirmed dengue patients were enrolled; the mean duration of illness at admission was five days. Of these, 88.6%, 10.7%, and 0.7% were classified according to the 1997 guidelines as having dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS), respectively. When the WHO 2009 guidelines were applied, 17.1%, 78.3%, and 4.6% were classified as dengue without warning signs, dengue with warning signs, and severe dengue, respectively. Conclusions: Our data suggests that the revised WHO 2009 guidelines stratify a much larger proportion of patients into a category that requires a higher level of medical and nursing care.
Warning signs
Dengue haemorrhagic fever
Cite
Citations (13)
Earliest detection of dengue infection and its complications in our resource-poor country is a grave challenge. It certainly reduces dengue associated mortality and morbidity. For this purpose, we set out to determine if the dengue NS1 antigen ELISA could be used as a point of care test to predict severe disease. 356 clinically suspected dengue patients with h/o<5days fever admitted in a tertiary care hospital were enrolled in this study. Clinical and laboratory parameters were recorded and the serum samples were tested using Panbio Dengue Early Elisa kit (Panbio, Australia) for detection of dengue NS1 antigen. In the study group (N=356), 25.28% were found to be reactive for dengue NS1 antigen. Maximum Seropositivity (55.56%) was seen in the age group of 15-45 years with the male:female ratio=2:1. Clinical features were significantly correlated with dengue seropositivity. 92.22% seropositive patients were found to be thrombocytopenic. It was highly significant (p<0.001). Dengue NS1 antigen is an important marker for early diagnosis of dengue infection, especially in the window period when dengue antibodies are not available in blood. Thrombocytopenia is an accessory laboratory finding to predict the impending complications (DHF, DSS).
Cite
Citations (0)
Dengue, an arthropod borne viral disease which is transmitted to humans through the bite of infected Aedes mosquitoes, can result in a range of clinical presentations from mild febrile illness like dengue fever (DF) to severe presentations like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) which can turn fatal.While majority of primary dengue cases are asymptomatic/ mild symptomatic, secondary dengue infected cases usually have more complications and require critical care support. To find out proportion of Dengue IgG among NS1 reactive cases, study their clinical-demographic profiles and to find out the prevalent dengue serotypes. Blood collected from patients suffering from acute febrile illness less than 5 days and more than 5 days duration were tested for Dengue NS1and Dengue IgM respectively. Samples reactive for Dengue NS1 were further tested for dengue IgG by ELISA and dengue serotyping by RT-PCR. Results obtained were analysed and interpreted. Out of 2286 blood samples suspected for Dengue during the study period (March 2021 to February 2022), only 134 samples were NS1 reactive and amongst them, 21 (16%) had early detection of IgG antibodies while the rest 113(84%) cases were primary dengue infection. The predominant serotype was DENV-3. It is evident that patients who suffer from Secondary Dengue infections require more supervision and critical care support. This highlights the importance of Dengue IgG detection in the early phase of the disease in order to predict the complications of dengue which can save many more lives. Nevertheless, Primary dengue infections can also be severe, hence should be monitored closely under supervision. Molecular surveillance may help to predict large scale outbreaks of dengue if regional shifts in the predominantly circulating serotypes are detected during the early phase of the dengue season.
Cite
Citations (0)
In Colombia, dengue is an endemic disease and the four serotypes have been reported.To describe the frequency and severity of dengue in an area of the Colombian Caribbean (Department of Cordoba).A retrospective study was conducted. Two data sources were analysed: The database from the Direction of Health in Córdoba, and clinical registers of patients diagnosed with haemorrhagic fevers and fevers of unknown origin in reference hospitals.The mean incidence of dengue between 2003-2010 was 36.5 cases/10(5) inhabitants (CI95%: 34.3-37.5) and adjusted for sub-reporting, could be between 178.5 and 521.6. The mean incidence of severe dengue was 4.7 cases/10(5) inhabitants (CI95%: 4.3-5.0). Mean mortality rate due to dengue was 0.3 cases/10(5) inhabitants. The fatality rate was below 1%. The mean total leukocyte count in patients with dengue was 6,181 mm(3) (CI95%: 5,973-6,389) and with severe Dengue was 4,729 mm(3) (CI95%: 4,220-5,238). The average platelet count in patients with Dengue was 118,793/mm(3) (CI95%: 107,255-130,331) and in patients with Severe Dengue 77,655 (CI95%: 59,640-95,670). Both differences were statistically significant (p <0.05). The frequency of laboratories test per patient in patients with Dengue and severe Dengue were different.The department of Cordoba is a highly endemic zone of Dengue and severe Dengue in the Colombian Caribbean. Moreover, the results show significant differences between dengue and severe dengue so much in tests as in frequency of use of healthcare services.en Colombia el Dengue es una enfermedad endémica en la que se han descrito los cuatro serotipos que la producen.Describir la frecuencia y severidad del Dengue en el departamento de Córdoba de la región caribe colombiana.Se llevó a cabo un estudio retrospectivo a partir del análisis de dos fuentes de datos: a) la base de datos de los casos reportados a la dirección de salud departamental y b) los registros clínicos de pacientes con diagnóstico de fiebres hemorrágicas y fiebre de origen desconocido., en hospitales de referencia del departamento de Córdoba.La incidencia media de dengue entre 2003-2010 fue de 36.5 casos por cien mil habitantes (IC95%: 34.3-37.5) y ajustando por sub-registro podría estar entre 178.5 y 521.6. La incidencia media de dengue grave fue de 4.7 casos por cien mil habitantes (IC95%: 4.3-5.0). La tasa promedio de mortalidad por el dengue durante el período fue de 0.3 casos por cien mil habitantes. El recuento leucocitario total promedio en los pacientes con dengue fue 6,181 x mm3 (IC95%: 5,973-6,389) y con dengue grave fue 4,729 x mm3 (IC95%: 4,220-5,238). El recuento medio de plaquetas en pacientes con Dengue fue 118.793 / mm3 (IC95%: 107,255-130,331) y en pacientes con Dengue Grave fue 77,655 (IC95%: 59,640-95,670). Las diferencias fueron estadísticamente significativas (p <0.05). La frecuencia de los laboratorios de pruebas por paciente en los pacientes con dengue y dengue grave fueron diferentes.El departamento de Córdoba es una zona altamente endémica de dengue y dengue grave en el Caribe colombiano. Los resultados muestran diferencias significativas en algunas pruebas de laboratorio entre el dengue y el dengue severo.
Case fatality rate
Dengue haemorrhagic fever
Cite
Citations (7)
Objective: To determine the simple and specific clinical predictors to discriminate dengue infection from other acute febrile illnesses in resource-limited settings. Material and methods: Prospective study was conducted at Nakhonpathom Hospital, a 670-bed tertiary care hospital in Thailand during August 1 and October 31, 2015. The inclusion criteria were adults who presented with acute fever, clinically suspected to be dengue infection by attending physician. Predictive factors for dengue infection were analysed. Result: There were 155 patients. Mean age was 33.5 ± 17.1 yrs and 51% were female. One hundred and thirteen patients (73%) had dengue and 42 (27%) had non-dengue. Factors associated with dengue including absence of cough (OR 0.3, 95%CI 0.1;0.9, p = 0.04), WBC ≤ 4x10 3 /mm 3 (OR 4.6, 95%CI 1.2;17.0, p 0.02), platelet ≤ 100x10 3 /mm 3 (OR 6.6, 95%CI 1.5;29.8, p = 0.01) and ESR ≤ 20 mm/hr (OR 3.3, 95%CI 1.01;12.3, p = 0.047). Dengue score was calculated as follows (variables coded as absence = 0, presence =1): (-1.3xcough) + (1.5xWBC<4X10 3 /mm 3 ) + (1.9xplatelet<100x10 3 /mm 3 ) + (1.2xESR<20). A score ≥ 2 was the best cut-off point for predicting dengue with sensitivity, specificity, PPV and NPV of 58%, 95%, 98% and 38%, respectively. Conclusions: Clinical presentation of dengue was similar to other acute febrile illnesses. Dengue score provides a very high specificity and PPV and can be used to diagnose dengue infection in resource-limited settings. วตถประสงค : เพอศกษาลกษณะทางคลนกและการตรวจทางหองปฏบตการทงายและจำเพาะในการวนจฉยแยกโรคตดเชอไวรสเดงกกบโรคตดเชอฉบพลนอนๆ ในประเทศทมทรพยากรจำกด วสดและวธการศกษา : เปนการศกษาไปขางหนาในโรงพยาบาลนครปฐม โรงพยาบาลตตยภม ขนาดเตยง 670 เตยง ระหวางวนท 1 สงหาคม ถง 31 ตลาคม 2558 กลมตวอยางทเลอกเขาทำการศกษาคอ ผปวยผใหญ มไขฉบพลน และแพทยผดแลสงสยโรคตดเชอไวรสเดงก นำมาวเคราะหหาปจจยทางคลนกในการวนจฉยโรคตดเชอไวรสเดงก ผลการศกษา : ผปวยทงสน 155 ราย อายเฉลย 33.5 ± 17.1 ป รอยละ 51 เปนเพศหญง พบการตดเชอไวรสเดงก 113 ราย (รอยละ 73) และการตดเชออนๆ 42 ราย (รอยละ 27) ปจจยทำนายการตดเชอไวรสเดงก ไดแก การไมมอาการไอ (OR 0.3, 95%CI 0.1;0.9, p = 0.04), WBC ≤ 4x10 3 /mm 3 (OR 4.6, 95%CI 1.2;17.0, p 0.02), platelet ≤ 100x10 3 /mm 3 (OR 6.6, 95%CI 1.5;29.8, p = 0.01) และ ESR ≤ 20 mm/hr (OR 3.3, 95%CI 1.01;12.3, p = 0.047) เมอนำปจจยดงกลาวมาวเคราะหหา Dengue Score โดยการไมมปจจยดงกลาวใหคะแนน = 0 และการมปจจยดงกลาวใหคะแนน = 1 ไดดงน (-1.3xcough) + (1.5xWBC<4X10 3 /mm 3 ) + (1.9xplatelet<100x10 3 /mm 3 ) + (1.2xESR<20) โดยถา Dengue score มากกวาหรอเทากบ 2 จะสามารถใชวนจฉยโรคตดเชอไวรสเดงกได มความไว ความจำเพาะ คาทำนายผลบวก และคาทำนายผลลบ เทากบรอยละ 58, รอยละ 95, รอยละ 98 และรอยละ 38 ตามลำดบ สรป : อาการและอาการแสดงของโรคตดเชอไวรสเดงกคลายการตดเชอฉบพลนอนๆ แยกออกจากกนไดยาก Dengue Score สามารถใชในการวนจฉยโรคตดเชอไวรสเดงกไดอยางแมนยำในประเทศทมทรพยากรจำกด
Cite
Citations (0)
Because healthcare facilities in many dengue endemic countries lack laboratory support, early dengue diagnosis must rely on either clinical recognition or a bedside diagnostic test. We evaluated the sensitivity and specificity of the 1997 and 2009 World Health Organization (WHO) dengue classification schemes and the NS1 strip test in acute sera from 154 virologically confirmed dengue patients and 200 patients with other febrile illnesses. Both WHO classification schemes had high sensitivity but lacked specificity. The NS1 strip test had high specificity, but its sensitivity was significantly lower in secondary compared with primary dengue infections. Differences in viral serotypes did not affect the performance of any of the three diagnostic approaches. Taken collectively, our findings indicate that the 1997 WHO dengue case definition can be used to exclude dengue, and the NS1 strip test can be used to confirm dengue infection, although the latter should be interpreted with caution in regions where secondary dengue infection is prevalent.
Rapid diagnostic test
Cite
Citations (129)
Background: Dengue fever is an endemic and potentially fatal viral infection threatening more than 2.5 million people in over 100 regions around the world - hence the need for timely and accurate diagnosis using an easy and affordable assay. Methods: In our study, the use of a commercial dengue antigen-capture ELISA (PLATELIA DENGUE NS1 AG by Bio-Rad) was evaluated to demonstrate its usefulness in diagnosing acute dengue viral infection in an acute tertiary centre in Singapore. Our country is endemic for dengue fever with more than 7000 cases reported in 2008. Retrospective analysis was performed on 197 patients in whom serum dengue antigen-capture ELISA was carried out. The diagnosis of dengue was made based on dengue IgM positivity and the presence of classic clinical features of dengue fever. Results: A total of 75 patients were identified to have dengue fever. The overall sensitivity of dengue antigen-capture ELISA was 64% (48/75). Sensitivity was 81.5% when testing was carried out on serum samples taken during Day 1 to 4 of fever, 59.4% during Day 5-6 and 42.9% during Day 7-8. In patients who did not have dengue fever, the specificity was 100%. Conclusion: The results suggest that the dengue antigen-capture ELISA is most useful in the diagnosis of dengue fever within the first 4 days of fever. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive
Cite
Citations (1)
To check the profile of dengue fever applying WHO grading system. To know the outcome of patients according to the grading system. Background- Dengue virus causes spectrum of clinical manifestations which can be graded according to WHO grading system. Our study included 131 laboratory confirmed cases of dengue infection. WHO criteria were applied to them and patients were classified into Dengue Fever , Dengue Hemorrhagic fever and Dengue shock syndrome. Patients were followed up throughout their course of hospital stay till discharge/death .Patients were classified on basis of interventions done-like fluid replacement, blood transfusion. Classical Dengue fever (classical DF), Dengue Haemorrhagic fever ( DHF), Dengue Shock syndrome (DSS), Platelet count. Out of 131 patients 60% were found to have Dengue fever,36% with Dengue hemmorhagic fever and 4.5% with Dengue shock syndrome. Majority of patients with Dengue hemmorhagic fever and Dengue shock syndrome required interventions and had longer duration of hospital stay. WHO criteria for grading of dengue helps us to assess the severity and also segregate the patients who need aggressive management.
Dengue haemorrhagic fever
Grading (engineering)
Cite
Citations (3)