Host biomarkers distinguish dengue from leptospirosis in Colombia: a case-control study.
BACKGROUND
Dengue fever and leptospirosis have partially overlapping geographic distributions, similar clinical presentations and potentially life-threatening complications but require different treatments. Distinguishing between these cosmopolitan emerging pathogens represents a diagnostic dilemma of global importance. We hypothesized that perturbations in host biomarkers can differentiate between individuals with dengue fever and leptospirosis during the acute phase of illness.


METHODS
We randomly selected subjects from a prospective cohort study of acute febrile illness in Bucaramanga, Colombia and tested 19 serum biomarkers by ELISA in dengue fever (DF, n = 113) compared to subjects with leptospirosis (n = 47). Biomarkers were selected for further analysis if they had good discriminatory ability (area under the ROC curve (AUC) >0.80) and were beyond a reference range (assessed using local healthy controls).


RESULTS
Nine biomarkers differed significantly between dengue fever and leptospirosis, with higher levels of Angptl3, IL-18BP, IP-10/CXCL10, Platelet Factor 4, sICAM-1, Factor D, sEng and sKDR in dengue and higher levels of sTie-2 in leptospirosis (p < 0.001 for all comparisons). Two biomarkers, sEng and IL18BP, showed excellent discriminatory ability (AUROC >0.90). When incorporated into multivariable models, sEng and IL18BP improved the diagnostic accuracy of clinical information alone.


CONCLUSIONS
These results suggest that host biomarkers may have utility in differentiating between dengue and leptospirosis, clinically similar conditions of different etiology.
Andrea L
AL
Conroy
Margarita
M
Gélvez
Michael
M
Hawkes
Nimerta
N
Rajwans
W Conrad
WC
Liles
Luis Angel
LA
Villar-Centeno
Sandra A, Rotman Laboratories, Sandra Rotman Centre, University Health Network-Toronto General Hospital, University of Toronto, Toronto M5G 1 L7, Canada. kevin.kain@uhn.on.ca.
Kevin C
KC
Kain
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003105:Colombia; D003715:Dengue / Q000097:blood / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D054884:Host-Pathogen Interactions; D006801:Humans; D007922:Leptospirosis / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
D015415:Biomarkers