BackgroundThe 2009 revised World Health Organization (WHO) guidelines for dengue describe fever as the core symptom. Accordingly, the diagnosis of non-febrile patients is complicated. The aim of this study was to evaluate the importance of fever in patients with dengue according to the 2009 revised WHO classification.MethodsIn this study, we assessed 30,670 dengue cases using enzyme-linked immunosorbent assay, detection of the non-structural protein 1, or polymerase chain reaction for diagnostic confirmation. Fisher’s exact test was used to evaluate associations between fever and related clinical manifestations. The Mann–Whitney U test was used to assess the association of dengue classification with fever and time to treatment. The effects of fever and time to treatment on the risk of progression were analyzed using an ordinal logistic regression to stereotype the model.ResultsDisease classification was found to associate significantly with both fever and time to treatment (both P < 0.001). Non-febrile patients were nearly four-fold more likely to exhibit “dengue without warning signs” than “severe dengue” (odds ratio [OR] = 3.74; 95% confidence interval [CI]: 3.20–4.36). Patients who received treatment within 7 days were twice as likely to have “dengue without warning signs” as opposed to “severe dengue” when compared to those who waited >7 days (OR = 2.23; 95% CI: 1.78–2.80). However, this difference was negligible in the multivariate analysis (OR = 1.02; 95% CI: 0.98–1.07).ConclusionsFever is a risk factor for disease progression in patients with dengue. However, non-febrile patients should not be neglected because this may delay treatment and could lead to more severe disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2128-4) contains supplementary material, which is available to authorized users.

BackgroundThe aim of this study was to evaluate the utility of the tourniquet test (TT) for dengue diagnosing. To our knowledge, no previous study with such a large sample, of this duration, with as many laboratory methods referenced, or relating the results of the TT to the 2009 WHO classification of severity has been conducted thus far.MethodsIn this study, we analyzed the records of 119,589 suspected dengue cases in a Brazilian city, with 30,670 confirmed cases. The Cohen’s Kappa test was applied to evaluate the degree of agreement between the tests, and the sensitivity and specificity was calculated for the TT.ResultsTwenty-eight thousand six hundred thirty-five TT were performed. No association between the outcome of the TT and greater severity of infection, according to the 2009 guideline, was observed (P = 0.28); furthermore, relevant agreement with the final diagnosis (κ = 0.01; 95 % CI = 0.00 to 0.02) or individually with the IgM enzyme-linked immunoassay was not observed (κ = 0.05; 95 % CI = 0.04 to 0.06), and was even lower with PCR (κ = 0.27; 95 % CI = 0.06 to 0.49). Most importance of the TT was shown in relation to specificity (88.9 %; 95 % CI = 0.88 to 0.89) and negative predictive value (70.3 %; CI 95 % = 0.70 to 0.71).ConclusionsTT was more effective in detecting cases that were truly negative than positive. These results suggest that the TT should not be used as diagnosis of dengue.

Objetivo: Relatar um caso de amenorréia primária, a investigação ambulatorial desse quadro e discutir alterações genéticas e endocrinológicas envolvidas. Detalhamento de caso: Paciente do sexo feminino, com idade de 16 anos, encaminhada ao ambulatório de endocrinologia ginecológica por ausência de menarca e caracteres sexuais secundários hipodensenvolvidos. Ao exame físico broto mamário presente à esquerda e ausente no lado direito, pêlos axilares e vaginais esparsos, Tanner M1P1. Investigação ambulatorial com dosagens hormonais e imagens ultrassonográficas sugestivas de insuficiência ovariana, hipótese diagnóstica confirmada por cariotipagem com evidência de disgenesia gonadal. Posterior terapêutica com estradiol e seguimento para avaliação da resposta à terapia hormonal e realização de exames complementares. Considerações finais: O pseudo isodicêntrico X reflete uma alteração genética que resulta no quadro de hipogonadismo hipergonadotrófico e, tal condição fisiopatológica explica a amenorréia primária e o não desenvolvimento sexual secundário apresentados pela paciente em questão. Desdobramentos biológicos e psicossociais exigem abordagem terapêutica e seguimento médico pelos possíveis desfechos associados.