Simple Clinical and Laboratory Predictors of Chikungunya versus Dengue Infections in Adults

Abstract

BackgroundDengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF), is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making.MethodsWe compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR) with 917 dengue RT-PCR-positive adult patients (including 55 with DHF). We compared dengue fever (DF), DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables.FindingsAt first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF), nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets <118×109/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets <100×109/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable.InterpretationThere is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management.

Determination of Toll-Like Receptor-Induced Cytokine Profiles in the Blood and Cerebrospinal Fluid of Chikungunya Patients

“…However, the change in protein concentration may be related to other clinical predispositions; therefore, it would be rather difficult to draw any conclusions. Regarding the change in creatinine concentration in the CHIKV group compared with the non-CHIKV group, studies have associated a low creatinine level as a significant marker for persistent joint pain in Chikungunya [31], while others have stated higher creatinine levels as a predictor of Chikungunya [32]. In our study, in the CHIKV group, creatinine levels were higher than in the non-CHIKV group, which could reflect the association of arthralgia with Chikungunya in these cases.…”

Fatal cases of Chikungunya virus infection in Colombia: Diagnostic and treatment challenges

“…Studies suggest that thrombocytopenia is a useful tool for diagnosis of dengue in this context [8,9]. Although thrombocytopenia was present and anti-Dengue IgM was positive for two of our cases, the possibility of having a Dengue coinfection was rejected based on the results of RT-PCR.…”

Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014

“…The reasons behind these discrepancies are unknown, but may include environmental factors such as diet, human genetic factors, as well as CHIKV lineage and strain-specific variation in pathogenesis. The diagnostic value of differential CBC analysis has been a focus of debate among CHIKV researchers, as some epidemics include a large majority of patients presenting with profound lymphopenia [15] while other studies show that changes in lymphocyte counts may not be CHIKV-specific compared to other indications, namely dengue hemorrhagic fever [37]. In La Romana, CHIKV infection greatly increased the risk of lymphopenia, given reference values derived from a combination of sources, when compared to CHIKF(-) patients.…”