New parameters available on Sysmex XE-5000 hematology analyzers contribute to differentiating dengue from leptospirosis and enteric fever.
BACKGROUND
Distinguishing dengue virus infection from other febrile thrombocytopenic illnesses such as leptospirosis or enteric fever is important but difficult, due to the unavailability of reliable diagnostic tests. Sysmex XE-5000 hematology analyzers use fluorescence flow cytometry to quantitate new parameters including cells in the atypical lymphocyte area (AL), high-fluorescent lymphocyte counts (HFLC), immature granulocytes (IG), and immature platelets (IPF). This study aimed to investigate whether these parameters can help to discriminate between the diseases.


METHODS
We compared hematocytometry performed by a Sysmex XE-5000 analyzer in Indonesian adults with dengue (n = 93), leptospirosis (n = 11), and enteric fever (n = 6) infection, and in healthy controls (n = 28).


RESULTS
Receiver operating characteristic curves comparing dengue and leptospirosis showed that dengue was characterized by increased %AL (AUC 0.87; 95% CI 0.70-1.03), %HFLC (AUC 0.89; 95% CI 0.78-0.99), and %IPF (AUC 0.81; 95% CI 0.65-0.97), while patients with leptospirosis had increased %IG (AUC 0.86; 95% CI 0.71-1.02). Low %AL, %HFLC, and %IG supported a diagnosis of enteric fever.


CONCLUSIONS
The detection of AL, HFLC, IG, and IPF by Sysmex XE-5000 hematology analyzers can help to differentiate between common causes of febrile illnesses with thrombocytopenia in dengue endemic areas. We recommend further investigating the discriminatory value of these parameters in clinical practice.
Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
A
A
Oehadian
Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.|Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
M
M
Michels
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
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Q
de Mast
Department of Clinical Pathology, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
D
D
Prihatni
Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
M
M
Puspita
Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
Y
Y
Hartantri
Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
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S
Sinarta
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
A J A M
AJ
van der Ven
Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
B
B
Alisjahbana
D000293:Adolescent; D000328:Adult; D001792:Blood Platelets; D016022:Case-Control Studies; D003715:Dengue / Q000097:blood* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005434:Flow Cytometry; D006098:Granulocytes; D006801:Humans; D007922:Leptospirosis / Q000097:blood* / Q000175:diagnosis*; D007958:Leukocyte Count / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D007962:Leukocytes / Q000378:metabolism; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D012372:ROC Curve; D014435:Typhoid Fever / Q000097:blood* / Q000175:diagnosis*; D055815:Young Adult
Dengue; differential diagnosis; enteric fever; hematocytometry; leptospirosis