Hematologic Parameters of Acute Dengue Fever Versus Other Febrile Illnesses in Ambulatory Returned Travelers

Abstract

Purpose of Review Point-of-care dengue diagnostics are unavailable in most settings; thus, diagnosis is clinical until more definitive microbiological testing -such as serology -is resulted. Thrombocytopenia and lymphopenia are common hallmarks of dengue fever; however, neutropenia is a prominent, yet less frequently reported trend. We aimed to identify hematological patterns that can assist frontline clinicians with diagnostic certainty of dengue. Dengue patients presenting to our unit via the Emergency Department were compared to those presenting with other febrile illness (OFI) diagnoses. Patient demographics, day of illness, and neutrophil, lymphocyte, and platelet counts from days 1 to 14 of illness were collected, where available. Analyses were stratified by day of illness. Recent Findings Eighteen patients were included in the dengue group and 151 in the OFI group. The frequency of thrombocytopenia, neutropenia, and lymphopenia was each significantly greater in the dengue cohort than in the OFI group (p < 0.0001). Mean nadir platelet, neutrophil, and lymphocyte counts were significantly lower in the dengue cohort compared to those with OFI (p < 0.001), and the likelihood of a dengue patient having the constellation of thrombocytopenia, neutropenia, and lymphopenia on a single CBC during acute illness was 30-fold higher than in the OFI group (p < 0.0001). Summary As dengue-specific diagnostic testing is often limited by insensitive early serologic diagnostics with prolonged turnaround time, the constellation of thrombocytopenia, neutropenia, and lymphopenia can guide the early diagnostic and treatment approach as well as follow-up of febrile returned travelers with suspected dengue.

Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: a prospective cohort study

“…Such features have been commonly reported in the literature. [20][21][22] Exposure to standing water or mud, conjunctival injection and jaundice were associated with a diagnosis of leptospirosis, as previously reported in the literature. [23][24][25] As expected, patients with respiratory viral infection were more likely to report rhinitis/congestion, cough and lung crackles compared with patients with other aetiologies.…”

Profile of Dengue Fever Complication in Infant at Tertiary Referral Hospital in East Java, Indonesia

“…Neutropenia, along with thrombocytopenia and leukopenia are associated with DVI compared to patients with other febrile illnesses, and also can guide the early diagnostic approach to DVI. 23 The mean lymphocyte percentage in this study was 52.3%, which means that this result exceeds the normal value (23-49%). Lymphocytes generally increase in viral infections.…”

Prevalence of dengue virus, their infection, diagnosis, and challenges

“…In the past two decades, DENVs have been spreading worldwide very aggressively both as single serotype and concurrent multiple DENV infections. For example, in the 80s, DENV1 and DENV4 were mostly restricted in North Brazil [40]. However, DENV1 soon prevailed nationwide, and in 2009, the DENV1 again re-emerged inflicting an extensive epidemic in almost all areas of Brazil [41].…”