Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015.

• Published in: PLOS Neglected Tropical Diseases
• Main Authors: 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
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2017
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doi.org/10.1371/journal.pntd.0005859; https://doaj.org/article/068e202edd6b45cfa7af8fd95d4358c2

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 ...