Criterios clínicos para diagnosticar el dengue en los primeros días de enfermedad.

• Díaz, Fredi Alexander ^[1] ; Martínez, Ruth Aralí ^[1] ; Villar, Luis Angel
  1. [1] Universidad Industrial de Santander

     Universidad Industrial de Santander

     Colombia

     
• Localización: Biomédica. Revista del Instituto Nacional de Salud, ISSN-e 2590-7379, ISSN 0120-4157, Vol. 26, Nº. 1, 2006, págs. 22-30
• Idioma: español
• Títulos paralelos:
  • Clinical criteria to diagnose dengue in its early stages.
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• Resumen
  • español

    Introducción. La definición de caso de dengue de la Organización Mundial de la Salud (OMS) tiene alta sensibilidad, pero es muy inespecífica. Objetivo. Formular una escala diagnóstica de mayor exactitud que la definición de la OMS para la identificación clínica temprana del dengue en áreas endémicas. Materiales y métodos. En una cohorte de adultos (>12 años) con síndrome febril agudo sin causa aparente en Bucaramanga, Colombia, compuesta por 125 casos de dengue (confirmados serológica o virológicamente) y 126 de síndrome febril de otra etiología, se determinaron las manifestaciones clínicas tempranas (en los primeros cuatro días de la enfermedad) asociadas al dengue y con ellas se formularon y evaluaron diversas combinaciones diagnósticas. Resultados. La escala compuesta por exantema, prueba de torniquete positiva, ausencia de rinorrea, artralgias, ausencia de diarrea (1 punto por cada hallazgo), recuentos de leucocitos

  • English

    Introduction. Clinical differentiation of dengue from other diseases with similar symptoms is difficult. The case definition of the World Health Organization (WHO) has high sensitivity but its specificity is very low.Objective. A diagnostic scale was formulated for early clinical diagnosis of dengue that provided greater accuracy than that of the WHO definition.Materials And Methods. A cohort of 251 adults (> 12 years of age) with unspecific acute febrile syndrome was selected from clinics located in Bucaramanga, Colombia. They consisted of 125 cases of dengue (serologically and/or virologically confirmed) and 126 with other febrile diseases. Clinical manifestations encountered during the first four days of dengue disease were determined, along with the diverse diagnostic combinations that were presented.Results. : The scale consisted of the following criteria: presence of rash, positive tourniquet test, absence of nasal discharge, arthralgias, absence of diarrhea (1 point for each finding), leukocyte count < 4,000/mm3 (3 points) and platelet count < 180.000/mm3 (2 points). In a receiver-operating-characteristic curve, the predictive area of 81.0% was significantly superior to the one produced with WHO criteria, (70.0%, p < 0.001). Febrile syndrome with at least a 3 point score obtained the following values: sensitivity = 95.2%; specificity = 27.8%; positive predictive value = 56.7%; negative predicative value = 85.4%. With a 6-point score, sensitivity = 70.4%; specificity = 78.6%; positive predictive value = 76.5%; negative predicative value = 72.8%. With at least 8 points: sensitivity = 42.4%; specificity = 96%; positive predictive value = 91.4%; negative predictive value = 62.7%. With 9 or 10 points, specificity and positive predictive value were of 100%.Conclusion. The described scale proved useful for early clinical diagnosis of dengue, but requires validation for its application in endemic areas.