title: Differentiating between dengue fever and malaria using hematological parameters in endemic areas of Thailand.
abstract: BACKGROUND
  Dengue fever (DF) and malaria are the two major public health concerns in tropical countries such as Thailand. Early differentiation between dengue and malaria could help clinicians to identify patients who should be closely monitored for signs of dengue hemorrhagic fever or severe malaria. This study aims to build knowledge on diagnostic markers that are used to discriminate between the infections, which frequently occur in malaria-endemic areas, such as the ones in Thailand.
  
  
  METHODS
  A retrospective study was conducted in Phop Phra Hospital, a hospital located in the Thailand-Burma border area, a malaria-endemic area, between 2013 and 2015. In brief, data on 336 patients infected with malaria were compared to data on 347 patients infected with DF.
  
  
  RESULTS
  White blood cells, neutrophil, monocyte, eosinophil, neutrophil-lymphocyte ratio, and monocyte-lymphocyte ratio were significantly lower in patients with DF compared to patients with malaria (P < 0.0001). In contrast, red blood cells, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were significantly higher in patients with DF as compared to patients with malaria (P < 0.0001). A decision tree model revealed that using neutrophils, lymphocyte, MCHC, and gender was guided to discriminate between dengue and malaria infection.
  
  
  CONCLUSIONS
  This study concluded that several hematological parameters were different for diagnosing DF and malaria. A decision tree model revealed that using neutrophils, lymphocyte, MCHC, and gender was guided to discriminate patients with dengue and malaria infection. In addition, using these markers will thus lead to early detection, diagnosis, and prompt treatment of these tropical diseases.
authors.affiliation: Medical Technology Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80161, Thailand. manas.ko@wu.ac.th.
authors.forename: Manas
authors.initials: M
authors.lastname: Kotepui
authors.affiliation: Medical Technology Laboratory, Phop Phra Hospital, PhopPhra District, Tak Province, 63160, Thailand.
authors.forename: Bhukdee
authors.initials: B
authors.lastname: PhunPhuech
authors.affiliation: Medical Technology Laboratory, Phop Phra Hospital, PhopPhra District, Tak Province, 63160, Thailand.
authors.forename: Nuoil
authors.initials: N
authors.lastname: Phiwklam
authors.affiliation: Medical Technology Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80161, Thailand.
authors.forename: Kwuntida
authors.initials: K
authors.lastname: Uthaisar
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001772:Blood Cell Count / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D003663:Decision Trees; D003710:Demography; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D004909:Erythrocyte Indices; D005260:Female; D005334:Fever / Q000209:etiology; D006400:Hematocrit; D006403:Hematologic Tests; D006801:Humans; D007958:Leukocyte Count; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D002052:Myanmar / Q000453:epidemiology; D012189:Retrospective Studies; D019595:Severe Dengue / Q000175:diagnosis / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Dengue; Hematological parameters; Malaria; Markers