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Can doctors make an accurate diagnosis of dengue infections at an early stage?



Can doctors make an accurate diagnosis of dengue infections at an early stage?



Dengue Bulletin 23: 1-9



As part of a multicentre, prospective study of dengue pathophysiology, this study was conducted to evaluate clinical findings and simple laboratory tests to find early indicators for the diagnosis of dengue infections so that control actions could be taken as early as possible to prevent the spread of dengue in the community. 12 febrile patients were enrolled each week between 1994 and 1997, from the outpatient department of 2 hospitals in Thailand, Children's Hospital in Bangkok and Kampangpet Provincial Hospital. A total of 649 febrile children (aged 6 months to 15 years) with a flushed face and without signs of localized infection were subjected to physical examination. Of the children examined, 318 were confirmed to have dengue: 176 had dengue fever (DF), and 142 had dengue haemorrhagic fever (DHF). Another 331 children had other self-limiting febrile illness (OFI). Comparisons between the clinical and simple laboratory indicators for the 2 groups of patients, DHF/DF and OFI, were performed. Results revealed that tourniquet test (TT) positive or leukopenia were the 2 tests that had a high sensitivity of about 90% for the diagnosis of dengue patients. However, their specificity and positive predictive values (PPV) were only 50-60% and 60-70%, respectively. If the 2 tests were combined, the sensitivity gets reduced to 74%, whereas the specificity and PPV were increased to 85% and 83%, respectively. It is concluded that for early, effective and rapid control of dengue outbreak, TT or leukopenia is a good indicator for initiating immediate control measures.

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