title: Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections.
abstract: In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs.
authors: Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. oal9@cdc.gov
authors: Olga D
authors: OD
authors: Lorenzi
authors: Christopher J
authors: CJ
authors: Gregory
authors: Luis Manuel
authors: LM
authors: Santiago
authors: Héctor
authors: H
authors: Acosta
authors: Ivonne E
authors: IE
authors: Galarza
authors: Elizabeth
authors: E
authors: Hunsperger
authors: Jorge
authors: J
authors: Muñoz
authors: Duy M
authors: DM
authors: Bui
authors: M Steven
authors: MS
authors: Oberste
authors: Silvia
authors: S
authors: Peñaranda
authors: Carlos
authors: C
authors: García-Gubern
authors: Kay M
authors: KM
authors: Tomashek
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology*; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D004769:Enterovirus Infections / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011647:Puerto Rico / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
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