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

Abstract

BackgroundDengue 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 FindingsA 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/SignificanceThe 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.

Concurrent Infection with <b><i>Plasmodium vivax</i></b> and the Dengue and Chikungunya Viruses in a Paediatric Patient from New Delhi, India in 2016

“…It is therefore difficult to differentiate these 3 infections on the basis of the clinical condition alone. A previous study showed that fever may be prolonged in cases of concurrent infections [15] . Thus, laboratory diagnosis along with the clinical symptoms might assist the clinicians in making an accurate diagnosis.…”

“…It has been previously shown that a dengue and malaria co-infection requires special attention because a delayed diagnosis and inappropriate treatment can result in fatal complications [16,17] or an aggravated host immune response [18] . In some patients, concurrent infections are more severe than mono-infections [15,18] ; others show no difference between co-infections and isolated infections [19] . Thus, an appropriate, differential, and timely diagnosis of pathogens and the correlation with disease severity of mono-versus coinfections are important for effective patient management.…”

Dengue nos Países da Lusofonia: Que Ligações Epidemiológicas Poderemos Traçar?

“…4,6,14 Níveis isolados de proteína C reativa (PCR) podem ser, nos locais onde se tenha acesso ao teste, um biomarcador útil para diferenciar doentes com baixo risco de malária e dengue em áreas onde as doenças coexistam. 15 O tratamento é de suporte. 4,6 Fluidoterapia, repouso no leito e antipiréticos podem ser suficientes nas formas não graves.…”

Insecticidal and biological effects of three plant extracts tested against the dengue vector, Stegomyia agyptii (Diptera: Culicidae)

“…It is most prevalent in tropical and subtropical regions around the world, predominantly in urban and semi-urban regions (Muhammad et al, 2015). In tropical and subtropical countries, outbreak of dengue results in thousands of deaths, human suffering and massive economic losses (Epelboin et al, 2013 a-f Means±standard deviations (SD) followed by same letter within rows indicate no significant difference (Duncan's multiple range test, P<0.05). LC50, LC90, lethal concentration at 50% and 90%; LCL, lower confidence limits; UCL, upper confidence limits.…”

“…In tropical countries like India, outbreak of dengue result in thousands of hospital admissions, human suffering and massive economic losses however, early recognition and prompt treatment can lower the risk of developing this severe disease (Epelboin et al, 2013). However, there are no available vaccines or effective antiviral agents against the virus.…”