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Symptomatology associated with confirmed diagnosis of dengue: secondary analysis of surveillance data from Mexico
Sintomatología asociada al diagnóstico confirmado de dengue: análisis secundario de los datos de vigilancia de México
DOI:
https://doi.org/10.15446/rsap.v25n6.105424Palabras clave:
Dengue fever, clinical diagnosis, hemorrhagic dengue, Mexico, symptomatology (en)Dengue, hemorrágico, diagnóstico clínico, fiebre por dengue, México, sintomatología (es)
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Objective The complexity of dengue symptomatology makes accurate clinical diagnosis difficult. This study aimed at identifying signs and symptoms associated with laboratory-confirmed dengue among febrile patients suspected of having a vector-born infection.
Methods This was a secondary analysis of surveillance data collected for a period of six years by the Mexican Ministry of Health in the north-central state of San Luis Potosí. All health facilities reported clinical data and obtained blood samples for any patient with a febrile condition of unknown origin, and who also presented at least two of the following symptoms: headache, myalgia, arthralgia, and exanthema. The final sample of 23,983 individuals was analyzed using multinomial logistic regression to compute crude and adjusted odds ratios with 95% confidence intervals (OR; 95% CI). The dependent variable was the outcome of final laboratory diagnosis: dengue fever (DF), dengue hemorrhagic fever (DHF), and no dengue as reference category.
Results Eleven variables were statistically significant in crude analyses, but only 7 remained in the final adjusted model; four were positively associated with both DF and DHF: Exanthema (DF 2.92; 2.38-3.58, DHF 1.71; 0.72-4.03), retro-ocular pain (DF 1.24; 1.13-1.36, DHF 1.58; 1.09-2.28), being non-indigenous (DF 1.50; 1.25-1.80, DHF 5.69; 1.74-18.5) and adulthood (DF 1.44; 1.31-1.59, DHF 2.73; 1.75-4.26). Hemorrhage (79.3; 48.3-129.7), abdominal pain (2.50; 1.35-4.63) and arthralgia (3.23; 1.53-6.79) were also predictive, but only for DHF.
Conclusion We recommend health authorities worldwide to consider these findings when producing guidelines for clinical diagnosis to reduce over- and underdiagnosis.
Objetivo La complejidad sintomatológica del dengue dificulta el diagnóstico clínico preciso. Este estudio buscó identificar signos y síntomas asociados al dengue confirmado por laboratorio en pacientes febriles con sospecha de infección transmitida por vector.
Métodos Análisis secundario de datos de vigilancia recolectados en un periodo de seis años por la Secretaría de Salud de México en el estado norcentral de San Luis Potosí. Todos los establecimientos de salud reportaron datos clínicos y obtuvieron muestras de sangre de pacientes con fiebre de origen desconocido que presentaron al menos dos de los siguientes signos/síntomas: cefalea, mialgia, artralgia y exantema. La muestra final de 23 983 personas se analizó con regresión logística multinomial para calcular razones de momios (RM) crudas y ajustadas con intervalos de confianza (IC) de 95%. La variable dependiente fue el diagnóstico por laboratorio: fiebre de dengue (FD), dengue hemorrágico (DH), y no dengue como referencia.
Resultados Once variables fueron estadísticamente significativas en los análisis crudos, pero solo siete permanecieron en el modelo ajustado; cuatro se asociaron positivamente con FD y DH: exantema (FD 2,92; 2,38-3,58, DH 1,71; 0,72-4,03), dolor retroocular (FD 1,24; 1,13-1,36, DH 1,58; 1,09-2,28), ser no indígena (FD 1,50; 1,25-1,80, DH 5,69; 1,74-18,5) y ser adulto (FD 1,44; 1,31-1,59, DH 2,73; 1,75-4,26). La hemorragia (79,3; 48,3-129,7), el dolor abdominal (2,50; 1,35-4,63) y las artralgias (3,23; 1,53-6,79) también fueron predictoras, pero solo de DH.
Conclusión Se recomienda a las autoridades sanitarias tener en cuenta estos hallazgos al elaborar directrices para el diagnóstico clínico con el fin de reducir el sobre e infradiagnóstico.
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