Early diagnosis of dengue disease severity in a resource-limited Asian country

doi:10.1186/s12879-016-1849-8

. 2016 Sep 26;16(1):512.

doi: 10.1186/s12879-016-1849-8.

Early diagnosis of dengue disease severity in a resource-limited Asian country

Philippe Cavailler ^{1

2}, Arnaud Tarantola ³, Yee Sin Leo ^{4

5}, Andrew A Lover ^{4

6}, Anne Rachline ³, Moniboth Duch ⁷, Rekol Huy ⁸, Ai Li Quake ⁴, Yuvatha Kdan ⁷, Veasna Duong ⁹, Jeremy L Brett ^{10

11}, Philippe Buchy ^{9

12}

Affiliations

¹ Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. pcavailler@gmail.com.
² Current address: Agence de Médecine Préventive, 13 Chemin du Levant, Ferney-Voltaire, 01210, France. pcavailler@gmail.com.
³ Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
⁴ Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
⁵ Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
⁶ Current address: Global Health Group, University of California, San Francisco, USA.
⁷ National Paediatric Hospital, Phnom Penh, Cambodia.
⁸ National Dengue Control Program (NDCP), National Center for Parasitological, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
⁹ Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
¹⁰ Medical Affairs Department, Sanofi Pasteur, Singapore, Singapore.
¹¹ Current address: Takeda Vaccines Pte Ltd., Singapore, Singapore.
¹² Current address: GlaxoSmithKline vaccines, 150 Beach road, Singapore, Singapore.

PMID: 27670906
PMCID: PMC5036306
DOI: 10.1186/s12879-016-1849-8

Early diagnosis of dengue disease severity in a resource-limited Asian country

Philippe Cavailler et al. BMC Infect Dis. 2016.

. 2016 Sep 26;16(1):512.

doi: 10.1186/s12879-016-1849-8.

Authors

Philippe Cavailler ^{1

2}, Arnaud Tarantola ³, Yee Sin Leo ^{4

5}, Andrew A Lover ^{4

6}, Anne Rachline ³, Moniboth Duch ⁷, Rekol Huy ⁸, Ai Li Quake ⁴, Yuvatha Kdan ⁷, Veasna Duong ⁹, Jeremy L Brett ^{10

11}, Philippe Buchy ^{9

12}

Affiliations

¹ Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. pcavailler@gmail.com.
² Current address: Agence de Médecine Préventive, 13 Chemin du Levant, Ferney-Voltaire, 01210, France. pcavailler@gmail.com.
³ Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
⁴ Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
⁵ Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
⁶ Current address: Global Health Group, University of California, San Francisco, USA.
⁷ National Paediatric Hospital, Phnom Penh, Cambodia.
⁸ National Dengue Control Program (NDCP), National Center for Parasitological, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia.
⁹ Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
¹⁰ Medical Affairs Department, Sanofi Pasteur, Singapore, Singapore.
¹¹ Current address: Takeda Vaccines Pte Ltd., Singapore, Singapore.
¹² Current address: GlaxoSmithKline vaccines, 150 Beach road, Singapore, Singapore.

PMID: 27670906
PMCID: PMC5036306
DOI: 10.1186/s12879-016-1849-8

Abstract

Background: Dengue is endemic throughout Cambodia, a country faced with significant health and economic challenges. We undertook a clinical study at the National Paediatric Hospital in Phnom Penh to evaluate clinical diagnostic parameters for dengue and predictors of disease outcome.

Methods: Between September 2011 and January 2013, all consecutive inpatients aged between 1 and 15 years and presenting with suspected dengue were enrolled. They were clinically assessed using both the 1997 and 2009 WHO dengue classifications. Specimens were collected upon admission and discharge and tested for dengue at Institut Pasteur in Cambodia.

Results: A total of 701 patients were screened. Of these, 79 % were dengue-confirmed by laboratory testing, and 21 % tested dengue-negative. A positive tourniquet test, absence of upper respiratory symptoms, leukopenia, thrombocytopenia, and elevated liver transaminases were independent predictors for laboratory-confirmed dengue among the children. The presence of several warning signs on hospital admission was associated with a concurrent laboratory-confirmed diagnosis of severe disease outcome.

Conclusions: The presence of two or more warning signs was associated with a concurrent laboratory-confirmed diagnosis of severe dengue at hospital admission. Thus, a cumulative score combining simple clinical parameters and first-line laboratory findings could be used to accurately predict dengue virus infection in pediatric populations, optimizing triage in settings with limited laboratory resources.

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Figures

Fig. 1

Fig. 1

Classification of cases according to the criteria of the WHO 1997/2009 case definitions for dengue, National Paediatric Hospital, Phnom Penh, Sep. 2011–Jan. 2013

Fig. 2

Fig. 2

Receiver operator characteristics (ROC) curves comparing the predictive accuracy for DHF, of various models integrating one or several warning signs and presenting the values of the Area Under Curve (AUC) coefficients. National Paediatric Hospital, Phnom Penh, Sep 2011–Jan. 2013

Fig. 3

Fig. 3

Received-operator characteristics (ROC) curves comparing the predictive accuracy for Severe Dengue of various models integrating one or several warning signs, and presenting the values of the Area Under Curve (AUC) coefficients. National Paediatric Hospital, Phnom Penh, Sep. 2011–Jan. 2013

See this image and copyright information in PMC

References

1. Huy R, Buchy P, Conan A, Ngan C, Ong S, Ali R, Duong V, Yit S, Ung S, Te V, Chroeung N, Phaektra NC, Uok V, Vong S. National dengue surveillance in Cambodia 1980–2008: epidemiological and virological trends and the impact of vector control. Bull World Health Organ. 2010;88:650–657. doi: 10.2471/BLT.09.073908. - DOI - PMC - PubMed
1. Farrar J, Focks D, Gubler D, Barrera R, Guzman MG, Simmons C, Kalayanarooj S, Lum L, McCall PJ, Lloyd L, Horstick O, Dayal-Drager R, Nathan MB, Kroeger A. Towards a global dengue research agenda. WHO/TDR Dengue Scientific Working Group. Trop Med Int Health. 2007;12(6):695–699. doi: 10.1111/j.1365-3156.2007.01838.x. - DOI - PMC - PubMed
1. Ramos MM, Tomashek KM, Arguello DF, Luxemburger C, Quinones L, Lang J, Munoz-Jordan JL. Early features of dengue infection in Puerto Rico. Trans R Soc Trop Med. 2009;103:878–884. doi: 10.1016/j.trstmh.200811009. - DOI - PubMed
1. Gregory CJ, Santiago LM, Arguello DF, Hunsperger E, Tomashek KM. Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area–Puerto Rico, 2007–2008. Am J Trop Med Hyg. 2010;82(5):922–929. doi: 10.4269/ajtmh.2010.09-0552. - DOI - PMC - PubMed
1. Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, Viramitrachai W, Ratanachu-eke S, Kiatpolpoj S, Innis BL, Rothman AL, Nisalak A, Ennis FA. Early clinical and laboratory indicators of acute dengue illness. J Inf Dis. 1997;176:313–321. doi: 10.1086/514047. - DOI - PubMed

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[1] Huy R, Buchy P, Conan A, Ngan C, Ong S, Ali R, Duong V, Yit S, Ung S, Te V, Chroeung N, Phaektra NC, Uok V, Vong S. National dengue surveillance in Cambodia 1980–2008: epidemiological and virological trends and the impact of vector control. Bull World Health Organ. 2010;88:650–657. doi: 10.2471/BLT.09.073908. - DOI - PMC - PubMed

[2] Huy R, Buchy P, Conan A, Ngan C, Ong S, Ali R, Duong V, Yit S, Ung S, Te V, Chroeung N, Phaektra NC, Uok V, Vong S. National dengue surveillance in Cambodia 1980–2008: epidemiological and virological trends and the impact of vector control. Bull World Health Organ. 2010;88:650–657. doi: 10.2471/BLT.09.073908. - DOI - PMC - PubMed

[3] Farrar J, Focks D, Gubler D, Barrera R, Guzman MG, Simmons C, Kalayanarooj S, Lum L, McCall PJ, Lloyd L, Horstick O, Dayal-Drager R, Nathan MB, Kroeger A. Towards a global dengue research agenda. WHO/TDR Dengue Scientific Working Group. Trop Med Int Health. 2007;12(6):695–699. doi: 10.1111/j.1365-3156.2007.01838.x. - DOI - PMC - PubMed

[4] Farrar J, Focks D, Gubler D, Barrera R, Guzman MG, Simmons C, Kalayanarooj S, Lum L, McCall PJ, Lloyd L, Horstick O, Dayal-Drager R, Nathan MB, Kroeger A. Towards a global dengue research agenda. WHO/TDR Dengue Scientific Working Group. Trop Med Int Health. 2007;12(6):695–699. doi: 10.1111/j.1365-3156.2007.01838.x. - DOI - PMC - PubMed

[5] Ramos MM, Tomashek KM, Arguello DF, Luxemburger C, Quinones L, Lang J, Munoz-Jordan JL. Early features of dengue infection in Puerto Rico. Trans R Soc Trop Med. 2009;103:878–884. doi: 10.1016/j.trstmh.200811009. - DOI - PubMed

[6] Ramos MM, Tomashek KM, Arguello DF, Luxemburger C, Quinones L, Lang J, Munoz-Jordan JL. Early features of dengue infection in Puerto Rico. Trans R Soc Trop Med. 2009;103:878–884. doi: 10.1016/j.trstmh.200811009. - DOI - PubMed

[7] Gregory CJ, Santiago LM, Arguello DF, Hunsperger E, Tomashek KM. Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area–Puerto Rico, 2007–2008. Am J Trop Med Hyg. 2010;82(5):922–929. doi: 10.4269/ajtmh.2010.09-0552. - DOI - PMC - PubMed

[8] Gregory CJ, Santiago LM, Arguello DF, Hunsperger E, Tomashek KM. Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area–Puerto Rico, 2007–2008. Am J Trop Med Hyg. 2010;82(5):922–929. doi: 10.4269/ajtmh.2010.09-0552. - DOI - PMC - PubMed

[9] Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, Viramitrachai W, Ratanachu-eke S, Kiatpolpoj S, Innis BL, Rothman AL, Nisalak A, Ennis FA. Early clinical and laboratory indicators of acute dengue illness. J Inf Dis. 1997;176:313–321. doi: 10.1086/514047. - DOI - PubMed

[10] Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, Viramitrachai W, Ratanachu-eke S, Kiatpolpoj S, Innis BL, Rothman AL, Nisalak A, Ennis FA. Early clinical and laboratory indicators of acute dengue illness. J Inf Dis. 1997;176:313–321. doi: 10.1086/514047. - DOI - PubMed

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Early diagnosis of dengue disease severity in a resource-limited Asian country

Affiliations

Early diagnosis of dengue disease severity in a resource-limited Asian country

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

Full Text Sources

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