title: Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil.
abstract: BACKGROUND
  Dengue is an acute febrile illness caused by an arbovirus that is endemic in more than 100 countries. Early diagnosis and adequate management are critical to reduce mortality. This study aims to identify clinical and hematological features that could be useful to discriminate dengue from other febrile illnesses (OFI) up to the third day of disease.
  
  
  METHODS
  We conducted a sectional diagnostic study with patients aged 12 years or older who reported fever lasting up to three days, without any evident focus of infection, attending an outpatient clinic in the city of Rio de Janeiro, Brazil, between the years 2005 and 2008. Logistic regression analysis was used to identify symptoms, physical signs, and hematological features valid for dengue diagnosis. Receiver-operating characteristic (ROC) curve analyses were used to define the best cut-off and to compare the accuracy of generated models with the World Health Organization (WHO) criteria for probable dengue.
  
  
  RESULTS
  Based on serological tests and virus genome detection by polymerase chain reaction (PCR), 69 patients were classified as dengue and 73 as non-dengue. Among clinical features, conjunctival redness and history of rash were independent predictors of dengue infection. A model including clinical and laboratory features (conjunctival redness and leukocyte counts) achieved a sensitivity of 81% and specificity of 71% and showed greater accuracy than the WHO criteria for probable dengue.
  
  
  CONCLUSIONS
  We constructed a predictive model for early dengue diagnosis that was moderately accurate and performed better than the current WHO criteria for suspected dengue. Validation of this model in larger samples and in other sites should be attempted before it can be applied in endemic areas.
authors: Germano Sinval Faria Teaching Primary Care Center/National School of Public Health, Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, 21041-210, Brazil. regina.daumas@gmail.com
authors: Regina P
authors: RP
authors: Daumas
authors: Sonia R L
authors: SR
authors: Passos
authors: Raquel V C
authors: RV
authors: Oliveira
authors: Rita M R
authors: RM
authors: Nogueira
authors: Ingebourg
authors: I
authors: Georg
authors: Keyla B F
authors: KB
authors: Marzochi
authors: Patrícia
authors: P
authors: Brasil
mesh_terms: D000328:Adult; D003715:Dengue / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D005260:Female; D005334:Fever / Q000175:diagnosis*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012372:ROC Curve; D013997:Time Factors; D055815:Young Adult
references: Can J Ophthalmol. 2006 Dec;41(6):741-6
references: 17224957
references: Pediatr Infect Dis J. 2008 Jan;27(1):43-8
references: 18162937
references: Am J Trop Med Hyg. 2005 Dec;73(6):1063-70
references: 16354813
references: Am J Trop Med Hyg. 2010 May;82(5):922-9
references: 20439977
references: Epidemiol Infect. 2006 Aug;134(4):820-5
references: 16371180
references: Infection. 2011 Apr;39(2):135-40
references: 21487790
references: PLoS Negl Trop Dis. 2008 Mar 12;2(3):e196
references: 18335069
references: Infection. 2008 Dec;36(6):570-4
references: 19020803
references: Biometrics. 1988 Sep;44(3):837-45
references: 3203132
references: Lancet. 1998 Sep 19;352(9132):971-7
references: 9752834
references: J Clin Microbiol. 1992 Mar;30(3):545-51
references: 1372617
references: PLoS Negl Trop Dis. 2012;6(3):e1562
references: 22413033
references: Biomedica. 2005 Sep;25(3):412-6
references: 16276688
references: Enferm Infecc Microbiol Clin. 2005 Dec;23(10):593-7
references: 16324548
references: Trop Med Int Health. 1998 Nov;3(11):859-65
references: 9855396
references: Rev Med Chil. 2006 Sep;134(9):1153-60
references: 17171217
references: PLoS Negl Trop Dis. 2011 Dec;5(12):e1400
references: 22163057
references: Am J Trop Med Hyg. 2010 Jan;82(1):128-35
references: 20065008
references: Stat Med. 2002 Aug 30;21(16):2409-19
references: 12210625
references: Int J Antimicrob Agents. 2010 Nov;36 Suppl 1:S40-2
references: 20833000
references: Clin Vaccine Immunol. 2009 Apr;16(4):589-91
references: 19193828
references: Emerg Infect Dis. 2003 Aug;9(8):1003-6
references: 12967502
references: Biomedica. 2006 Mar;26(1):22-30
references: 16929900
references: BMC Infect Dis. 2006 Jul 25;6:123
references: 16869969
references: Clin Vaccine Immunol. 2007 Jun;14(6):799-801
references: 17460116
references: Clin Microbiol Rev. 1998 Jul;11(3):480-96
references: 9665979
references: J Clin Virol. 2010 Sep;49(1):11-5
references: 20663710
references: BMC Bioinformatics. 2011 Mar 17;12:77
references: 21414208
references: Ann Acad Med Singap. 2006 Nov;35(11):783-9
references: 17160194
references: Mem Inst Oswaldo Cruz. 2011 May;106(3):255-6
references: 21655810
references: Trans R Soc Trop Med Hyg. 2009 Sep;103(9):878-84
references: 19111871
references: J Clin Virol. 2006 Feb;35(2):147-53
references: 16055371
references: Rev Panam Salud Publica. 2007 Nov;22(5):358-63
references: 18198045
references: Ann Trop Med Parasitol. 2003 Jun;97(4):415-9
references: 12831527
references: Southeast Asian J Trop Med Public Health. 2001 Sep;32(3):476-80
references: 11944702
references: Trans R Soc Trop Med Hyg. 2006 Aug;100(8):775-84
references: 16551470
references: J Clin Virol. 2009 Aug;45(4):276-80
references: 19451025
references: Singapore Med J. 2007 Jul;48(7):669-73
references: 17609831
references: PLoS Negl Trop Dis. 2010 Aug 31;4(8):
references: 20824173
references: J Clin Virol. 2007 Feb;38(2):101-5
references: 17142099
references: PLoS Negl Trop Dis. 2010 Jul 06;4(7):e738
references: 20625558
references: J Virol Methods. 2009 Feb;155(2):157-60
references: 19022293
references: Epidemiol Infect. 1998 Aug;121(1):151-6
references: 9747766
references: Science. 1988 Jun 3;240(4857):1285-93
references: 3287615
references: Trop Med Int Health. 2008 Nov;13(11):1328-40
references: 18803612
references: Rev Panam Salud Publica. 2011 Sep;30(3):248-54
references: 22069072