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Discriminating malaria from dengue fever in endemic areas: clinical and biological criteria, prognostic score and utility of the C-reactive protein: a retrospective matched-pair study in French Guiana
- Source :
- PLoS Neglected Tropical Diseases, PLoS Neglected Tropical Diseases, Public Library of Science, 2013, 7 (9), pp.e2420. ⟨10.1371/journal.pntd.0002420⟩, PLoS Neglected Tropical Diseases, 2013, 7 (9), pp.e2420. ⟨10.1371/journal.pntd.0002420⟩, PLoS Neglected Tropical Diseases, Vol 7, Iss 9, p e2420 (2013)
- Publication Year :
- 2012
-
Abstract
- Background Dengue and malaria are two major public health concerns in tropical settings. Although the pathogeneses of these two arthropod-borne diseases differ, their clinical and biological presentations are unspecific. During dengue epidemics, several hundred patients with fever and diffuse pain are weekly admitted at the emergency room. It is difficult to discriminate them from patients presenting malaria attacks. Furthermore, it may be impossible to provide a parasitological microscopic examination for all patients. This study aimed to establish a diagnostic algorithm for communities where dengue fever and malaria occur at some frequency in adults. Methodology/Principal Findings A sub-study using the control groups of a case-control study in French Guiana – originally designed to compare dengue and malaria co-infected cases to single infected cases – was performed between 2004 and 2010. In brief, 208 patients with malaria matched to 208 patients with dengue fever were compared in the present study. A predictive score of malaria versus dengue was established using .632 bootstrap procedures. Multivariate analysis showed that male gender, age, tachycardia, anemia, thrombocytopenia, and CRP>5 mg/l were independently associated with malaria. The predictive score using those variables had an AUC of 0.86 (95%CI: 0.82–0.89), and the CRP was the preponderant predictive factor. The sensitivity and specificity of CRP>5 mg/L to discriminate malaria from dengue were of 0.995 (95%CI: 0.991–1) and 0.35 (95%CI 0.32–0.39), respectively. Conclusions/Significance The clinical and biological score performed relatively well for discriminating cases of dengue versus malaria. Moreover, using only the CRP level turned to be a useful biomarker to discriminate feverish patients at low risk of malaria in an area where both infections exist. It would avoid more than 33% of unnecessary parasitological examinations with a very low risk of missing a malaria attack.<br />Author Summary The authors present a retrospective matched-pair study on dengue and malaria performed in French Guiana. These two infections are major public health concerns in tropical regions, especially in South America and Southeast Asia, where they affect neglected populations which makes them interesting to be published in a journal aiming to publish about neglected tropical diseases. Although the pathogeneses of these two arthropod-borne differ, their clinical and biological presentations are unspecific. During dengue epidemics, hundreds of patients are admitted weekly with diffuse pains and fever at the emergency room. Among them, it is difficult to accurately distinguish malaria attacks, which are far less frequent than dengue fever cases. Moreover, it may be impossible to provide a parasitological microscopic examination for all patients. We believe the results of the present study, based on a sample of n = 416 individual are worthwhile as they support evidence that biological factors can help to discriminate between the two, in areas where they co-exist in endemic areas. A simple prognostic score based on clinical and biological criteria was built, interesting and easy-to-use for physicians in tropical areas.
- Subjects :
- Male
Multivariate analysis
Epidemiology
Dengue fever
Dengue Fever
Dengue
0302 clinical medicine
Plasmodium Vivax
030212 general & internal medicine
Young adult
Child
Aged, 80 and over
lcsh:Public aspects of medicine
Middle Aged
3. Good health
French Guiana
Plasmodium Falciparum
C-Reactive Protein
Infectious Diseases
Child, Preschool
Biomarker (medicine)
Medicine
Female
Research Article
Neglected Tropical Diseases
Adult
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
Adolescent
lcsh:RC955-962
Anemia
030231 tropical medicine
Sensitivity and Specificity
Infectious Disease Epidemiology
Diagnosis, Differential
03 medical and health sciences
Young Adult
Internal medicine
parasitic diseases
medicine
Humans
Aged
Retrospective Studies
business.industry
Diagnostic Tests, Routine
Public Health, Environmental and Occupational Health
Case-control study
Infant
Tropical Diseases (Non-Neglected)
lcsh:RA1-1270
Retrospective cohort study
medicine.disease
Malaria
Biomarker Epidemiology
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
Case-Control Studies
Immunology
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Clinical Medicine
business
Subjects
Details
- ISSN :
- 19352735 and 19352727
- Volume :
- 7
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- PLoS neglected tropical diseases
- Accession number :
- edsair.doi.dedup.....2f9734ab5d8060de5f2bff237fda964d