Volume 108, Issue 11 , Pages 879-885, November 2009
Dengue Fever Scoring System: New Strategy for the Early Detection of Acute Dengue Virus Infection in Taiwan
Article Outline
Background/Purpose
Dengue fever is an important public health problem in Southern Taiwan. The purpose of this study was to develop a dengue scoring system using a three-stage process, which may be used as a guidance tool for the early diagnosis of dengue fever.
Methods
A retrospective study was conducted to identify factors useful for the early diagnosis of dengue fever. We assessed the clinical and laboratory features of 89 adult patients with dengue from 2002 to 2004 at a community-based hospital. They were compared with 14 patients with scrub typhus, 104 with Q fever, and 35 with murine typhus, which might present similar symptoms and signs as dengue infection. A scoring system was designed after analysis of the retrospective study and with the assistance of 10 expert clinicians. For the second stage, we evaluated efficiency in differentiating dengue fever from Q fever, scrub typhus and murine typhus in three hospitals from 2002 to 2005. For the third stage, we prospectively used the dengue scoring system for 498 cases that clinically were suspected as having dengue infection in the city of Kaohsiung from January 2006 to September 2006.
Results
The performance of the scoring system was 88.1% sensitivity, 94.9% specificity, 95.7% positive predictive value (PPV), and 86.1% negative predictive value (NPV). Evaluation of the scoring system at the third stage revealed 90.7% sensitivity, 86.9% specificity, 81.4% PPV, and 93.6% NPV.
Conclusion
The dengue scoring system had a high NPV that might be helpful in the early diagnosis of dengue fever in adults before laboratory data are available.
Key Words: dengue , murine typhus , Q fever , scoring system , scrub typhus
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References
- A study of febrile illnesses on the Thai-Myanmar border: predictive factors of rickettsioses . Southeast Asian J Trop Med Public Health . 2004;35:657–663
- Differentiating dengue virus infection from scrub typhus in Thai adults with fever . Am J Trop Med Hyg . 2003;68:536–538
- Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory features: application of logistic regression analysis . J Clin Virol . 2006;35:147–153
- Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic . J Microbiol Immunol Infect . 2006;39:121–129
- Characteristics of a dengue hemorrhagic fever outbreak in 2001 in Kaohsiung . J Microbiol Immunol Infect . 2004;37:266–270
- . Acute Q fever as a cause of acute febrile illness of unknown origin in Taiwan: report of seven cases . J Formos Med Assoc . 1997;96:295–297
- Incidence and risk factors of probable dengue virus infection among Dutch travellers to Asia . Trop Med Int Health . 2002;7:331–338
- . Prevalence of relative bradycardia in Orientia tsutsugamushi infection . Am J Trop Med Hyg . 2003;68:477–479
- . An evaluation of methods for estimating the area under the receiver operating characteristic (ROC) curve . Med Decis Making . 1985;5:149–156
- . More dengue, more questions . Emerg Infect Dis . 2005;11:740–741
- Viral haemorrhagic fevers . Br Med J . 1975;4:67–68 [Editorial]
- . Dengue in travelers . N Engl J Med . 2005;353:924–932
- Phylogenetic study of dengue-3 virus in Taiwan with sequence analysis of the core gene . Kaohsiung J Med Sci . 2008;24:55–62
- Acute hepatitis with or without jaundice: a predominant presentation of acute Q fever in southern Taiwan . J Microbiol Immunol Infect . 2004;37:103–108
PII: S0929-6646(09)60420-4
doi:10.1016/S0929-6646(09)60420-4
© 2009 Formosan Medical Association & Elsevier. Published by Elsevier Inc. All rights reserved.
Volume 108, Issue 11 , Pages 879-885, November 2009
