Oropouche virus infection in patients with acute febrile syndrome: Is a predictive model based solely on signs and symptoms useful?

Abstract

Background Oropouche fever is an infectious disease caused by the Oropouche virus (OROV). The diagnosis and prediction of the clinical picture continue to be a great challenge for clinicians who manage patients with acute febrile syndrome. Several symptoms have been associated with OROV virus infection in patients with febrile syndrome; however, to date, there is no clinical prediction rule, which is a fundamental tool to help the approach of this infectious disease. Objective To assess the performance of a prediction model based solely on signs and symptoms to diagnose Oropouche virus infection in patients with acute febrile syndrome. Materials and methods Validation study, which included 923 patients with acute febrile syndrome registered in the Epidemiological Surveillance database of three arbovirus endemic areas in Peru. Results A total of 97 patients (19%) were positive for OROV infection in the development group and 23.6% in the validation group. The area under the curve was 0.65 and the sensitivity, specificity, PPV, NPV, LR + and LR- were 78.2%, 35.1%, 27.6%, 83.6%, 1.20 and 0.62, respectively. Conclusions The development of a clinical prediction model for the diagnosis of Oropouche based solely on signs and symptoms does not work well. This may be due to the fact that the symptoms are nonspecific and related to other arbovirus infections, which confuse and make it difficult to predict the diagnosis, especially in endemic areas of co-infection of these diseases. For this reason, epidemiological surveillance of OROV in various settings using laboratory tests such as PCR is important.

Outbreak of Oropouche virus in frontier regions in western Amazon

“…The clinical manifestations are similar to the main known arboviruses, such as dengue, Zika, chikungunya, and yellow fever, characterized by the presence of an acute febrile condition, with clinical symptoms such as fever, headache, myalgia, arthralgia, and skin eruptions, and may evolve to meningitis or encephalitis ( 4 , 9 ), which complicates the establishment of a clinical prediction model for the diagnosis of OROV based on signs and symptoms alone ( 37 , 38 ). Although a peculiarity of OROV has been observed through reports of recurrence of symptoms, it is not noticed in other arboviruses ( 39 ).…”

“…The clinical manifestations caused by OROV consist of acute fever, accompanied by headache, myalgia, arthralgia, anorexia, dizziness, chills, nausea, vomiting, diarrhea, epigastric pain, photophobia, and retro-orbital pain ( 8 ). However, because they are non-specific and very similar to the symptoms caused by the more widespread arboviruses such as dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) ( 9 ), screening and diagnosis of Oropouche fever become a challenge ( 10 ).…”

Transmission risk of Oropouche fever across the Americas

“…Quinquefasciatus ), reveals the latent threat for future OROV emergence across the areas predicted [ 3 , 7 , 31 , 51 ]. Alternatively, OROV may already be present in multiple regions shown here, yet it has not been detected due to the lack of epidemiological awareness and precise clinical or laboratory diagnosis [ 5 ], as exemplified with the false negative OROV cases reported in Ecuador in 2018 [ 51 ].…”

“…A notable emerging zoonotic disease that remains poorly understood is Oropouche fever, caused by Oropouche virus (OROV), first described in Trinidad and Tobago in 1954. Oropouche fever presents as a syndrome clinically indistinguishable from other VBDs such as dengue, Zika, or Mayaro fevers, with symptoms commonly including fever, headache, and myalgia [ 4 , 5 ].…”

Oropouche Virus Exposure in Febrile Patients during Chikungunya Virus Introduction in the State of Amapá, Amazon Region, Brazil

“…Despite most cases are reported in the Amazon region, clinical infection by OROV has been reported in other regions of the country [ 20 , 21 ]. Disease caused by OROV in Brazil is similar to those caused by other arboviruses, including chikungunya, such as fever, headache, arthralgia, myalgia, nausea, and vomiting [ 22 ].…”