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Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic
- Source :
- PLoS Neglected Tropical Diseases, Vol 12, Iss 2, p e0006258 (2018), PLoS Neglected Tropical Diseases, BASE-Bielefeld Academic Search Engine
- Publication Year :
- 2018
- Publisher :
- Public Library of Science (PLoS), 2018.
-
Abstract
- Background Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. Methodology/Principal findings The new WHO 2009 classification of dengue divides suspected cases into three categories: dengue without warning signs, dengue with warning signs and severe dengue. We evaluated the WHO 2009 classification vs physicians’ subjective clinical diagnosis (gestalt clinical impression) in a large cohort of patients presenting to a tertiary care center in southern Sri Lanka hospitalized with acute febrile illness. We confirmed acute dengue in 388 patients (305 adults ≥ 18 years and 83 children), including 103 primary and 245 secondary cases, of 976 patients prospectively enrolled with AFI. At presentation, both adults and children with acute dengue were more likely than those with other AFI to have leukopenia and thrombocytopenia. Additionally, adults were more likely than those with other AFI to have joint pain, higher temperatures, and absence of crackles on examination whereas children with dengue were more likely than others to have sore throat, fatigue, oliguria, and elevated hematocrit and transaminases. Similarly, presence of joint pain, thrombocytopenia, and absence of cough were independently associated with secondary vs primary dengue in adults whereas no variables were different in children. The 2009 WHO dengue classification was more sensitive than physicians’ clinical diagnosis for identification of acute dengue (71.5% vs 67.1%), but was less specific. However, despite the absence of on-site diagnostic confirmation of dengue, clinical diagnosis was more sensitive on discharge (75.2%). The 2009 WHO criteria classified almost 75% as having warning signs, even though only 9 (2.3%) patients had evidence of plasma leakage and 16 (4.1%) had evidence of bleeding Conclusions/Significance In a large cohort with AFI, we identified features predictive of dengue vs other AFI and secondary vs primary dengue in adults versus children. The 2009 WHO dengue classification criteria had high sensitivity but low specificity compared to physicians’ gestaldt diagnosis. Large cohort studies will be needed to validate the diagnostic yield of clinical impression and specific features for dengue relative to the 2009 WHO classification criteria.<br />Author summary Dengue is an important cause of acute fever in the tropics that is difficult to distinguish from other common etiologies of fever. The World Health Organization (WHO) revised criteria for the clinical diagnosis and classification of acute dengue in 2009. The performance of these criteria has not been widely evaluated in countries where dengue is endemic. We confirmed acute dengue in 388 of 976 patients presenting with acute febrile illness (AFI) to the largest tertiary care center in the Southern Province of Sri Lanka. We found specific clinical features and laboratory investigations to be predictive of acute dengue versus other AFI. The new WHO 2009 classification was more sensitive than physicians’ clinical diagnosis for identification of acute dengue on admission to hospital, but also over-estimated the severity of illness. Further large cohort studies are warranted to validate the performance of the 2009 WHO criteria for diagnosis and prognosis of dengue in regions where the disease burden is high.
- Subjects :
- Male
Viral Diseases
Pediatrics
Abdominal pain
Medical Doctors
Health Care Providers
Dengue virus
Pathology and Laboratory Medicine
medicine.disease_cause
Polymerase Chain Reaction
Severity of Illness Index
Geographical locations
Dengue Fever
Dengue fever
Cohort Studies
Dengue
Tertiary Care Centers
0302 clinical medicine
Medicine and Health Sciences
Sore throat
Medical Personnel
030212 general & internal medicine
Child
Leukopenia
lcsh:Public aspects of medicine
Hematology
Middle Aged
3. Good health
Hospitalization
Professions
Infectious Diseases
Child, Preschool
Acute Disease
Female
Anatomy
medicine.symptom
Research Article
Neglected Tropical Diseases
Cohort study
Adult
medicine.medical_specialty
Asia
lcsh:Arctic medicine. Tropical medicine
Adolescent
Fever
lcsh:RC955-962
030231 tropical medicine
Pain
World Health Organization
Throat
Young Adult
03 medical and health sciences
Signs and Symptoms
Diagnostic Medicine
Physicians
Severity of illness
medicine
Humans
Severe Dengue
Epidemics
Sri Lanka
business.industry
Public Health, Environmental and Occupational Health
Biology and Life Sciences
lcsh:RA1-1270
Myalgia
Dengue Virus
Tropical Diseases
medicine.disease
Thrombocytopenia
Abdominal Pain
Health Care
People and Places
Population Groupings
Crackles
business
Neck
Subjects
Details
- ISSN :
- 19352735
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- PLOS Neglected Tropical Diseases
- Accession number :
- edsair.doi.dedup.....ee6ce23f6b9d0b0cae5c70ce98ace1e2