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Douglas KO, Gittens-St Hilaire M. First clinical reports of acute hantavirus and dengue infections among pregnant women in the Caribbean. Infect Dis (Lond) 2024; 56:564-574. [PMID: 38767622 DOI: 10.1080/23744235.2024.2348631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Hantavirus and dengue virus infections lead to diseases causing economic and public health concerns. Acute hantavirus infections can lead to similar clinical haemorrhagic signs as other endemic diseases including dengue and leptospirosis. METHODS Using a retrospective case analysis of pregnant dengue and hantavirus disease patients with clinical reports and compatible clinical laboratory information during pregnancy, we report the first evidence of dengue and hantavirus infections and a case of dual dengue and hantavirus infection among pregnant women in the Caribbean. Laboratory testing by enzyme-linked immunosorbent assay (ELISA) and non-structural protein 1 (NS1) for DENV and for hantavirus infection pseudotype focus reduction neutralisation tests (pFRNT), ELISA and immunochromatographic (ICG) strips. RESULTS Four pregnant cases with acute DENV infections were identified; however, only one out of the four cases (25%) had a detailed medical record to permit abstraction of clinical data. Six hantavirus infected pregnant cases were identified with gestation periods ranged from 36 to 39 weeks; none of the reported patients exhibited previous pregnancy complications prior to hospitalisation and infection. Acute liver damage was observed in three of the six cases (AST readings) who were subsequently diagnosed with hepatitis in pregnancy and variable clinical outcomes were observed with term and pre-term deliveries. CONCLUSIONS Whilst hantavirus infection in pregnancy is rare, consideration should be given to differential diagnosis with fever, kidney involvement, liver involvement, haemorrhagic symptoms and thrombocytopenia in endemic areas with clinically similar diseases such as dengue and leptospirosis.HighlightsFirst recorded case of hantavirus and dengue co-infection in a pregnant woman.First detailed report of clinical hantavirus infection in pregnant women in the Caribbean.First published report of clinical dengue infection in pregnant woman in the Caribbean.Possible complications of pregnancy following hantavirus infection.Pre-term birth and low birth weights.Clinical course of hantavirus infection in a Caribbean population.
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Affiliation(s)
- Kirk Osmond Douglas
- Centre for Biosecurity Studies, University of the West Indies, Cave Hill, St. Michael, Barbados, West Indies
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Brockmann J, Kleines M, Ghaffari Laleh N, Kather JN, Wied S, Floege J, Braun GS. A simple clinical score to reduce unnecessary testing for Puumala hantavirus. PLoS One 2024; 19:e0304500. [PMID: 38820375 PMCID: PMC11142550 DOI: 10.1371/journal.pone.0304500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes nephropathia epidemica (NE), an endemic form of transient acute renal injury (AKI). Serological testing is the mainstay of diagnosis. It was the aim of the present study to assist decision-making for serological testing by constructing a simple tool that predicts the likelihood of PUUV positivity. METHODS We conducted a comparative cohort study of all PUUV-tested cases at Aachen University tertiary care center in Germany between mid-2013 and mid-2021. N = 293 qualified for inclusion; N = 30 had a positive test result and clinical NE; N = 263 were negative. Two predictive point scores, the Aachen PUUV Score (APS) 1 and 2, respectively, were derived with the aid of logistic regression and receiver operating characteristic (ROC) analysis by determining the presence of four admission parameters. For internal validation, the internal Monte Carlo method was applied. In addition, partial external validation was performed using an independent historic cohort of N = 41 positive cases of NE. RESULTS APS1 is recommended for clinical use as it estimated the probability of PUUV positivity in the entire medical population tested. With a range from 0 to 6 points, it yielded an area under the curve of 0.94 by allotting 2 points each for fever or headache and 1 point each for AKI or LDH>300 U/L. A point sum of 0-2 safely predicted negativity for PUUV, as was confirmed in the NE validation cohort. CONCLUSION Here, we present a novel, easy-to-use tool to guide the diagnostic management of suspected PUUV infection/NE and to safely avoid unnecessary serological testing, as indicated by point sum class 0-2. Since 67% of the cohort fell into this stratum, half of the testing should be avoidable in the future.
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Affiliation(s)
- Justus Brockmann
- Department of Nephrology and Rheumatology, RWTH University Hospital Aachen, Aachen, Germany
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Michael Kleines
- Division of Virology, Center of Laboratory Diagnostics, RWTH University Hospital Aachen, Aachen, Germany
| | - Narmin Ghaffari Laleh
- Medical Faculty Carl Gustav Carus, Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Jakob Nikolas Kather
- Medical Faculty Carl Gustav Carus, Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Stephanie Wied
- Department of Medical Statistics, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Department of Nephrology and Rheumatology, RWTH University Hospital Aachen, Aachen, Germany
| | - Gerald S. Braun
- Department of Nephrology and Rheumatology, RWTH University Hospital Aachen, Aachen, Germany
- Department of Nephrology, Klinikum Coburg, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
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İnce N, Öne K, Sav T, Sungur MA, Menemenlioğlu D. An evaluation of suspected cases of Hantavirus infection admitted to a tertiary care university hospital in Düzce, Turkey, between 2012 and 2018. Turk J Med Sci 2021; 51:288-296. [PMID: 33021756 PMCID: PMC7991866 DOI: 10.3906/sag-1912-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 10/06/2020] [Indexed: 11/06/2022] Open
Abstract
Background/aim Hantavirus is a rodent borne zoonosis caused by the members of the virus family Bunyaviridae, genus
Hantavirus
. In this study, we aimed to determine the role of peripheral blood leukocyte ratio in differential diagnosis of Hantavirus disease. Materials and methods The medical records of patients at the Düzce University Medical Faculty were examined retrospectively. A total of 20 patients diagnosed with hantavirus infection confirmed by serologic tests were included in the study (Group 1). The other group consisted of 30 patients suspected of hantavirus infection but found negative (Group 2). Demographic, clinical and laboratory characteristics, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte (LMR) ratios of both groups were compared. Results As a result of the istatistics analysis, no difference was found between the groups’ age, sex, and clinical complaints except lethargy-weakness (P = 0.004) and diarrhea (P < 0.001). Hemogram analysis showed a significant difference between the groups in terms of leukocyte, hemoglobin, hematocrit, platelet, mean platelet volume (P < 0.05) and PLR (P = 0.001) and LMR (P = 0.003) values from peripheral blood leukocyte ratios. Conclusion In conclusion, NLR, PLR, and LMR ratios may be useful for clinicians in differential diagnosis of Hantavirus in patients presenting with similar symptoms of Hantavirus disease.
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Affiliation(s)
- Nevin İnce
- Department of Infectious Diseases and Clinical Microbiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Kürşad Öne
- Department of Nephrology, Internal Diseases, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Tansu Sav
- Department of Nephrology, Internal Diseases, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Dilek Menemenlioğlu
- Department of Microbiology Reference Laboratories, National Arboviruses and Viral Zoonoses Unit Public Health Institution of Turkey, Ankara, Turkey
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Wang WJ, Zhao J, Yang JS, Liang MM, Ni MY, Yang JH. Clinical analysis of patients with acute pancreatitis complicated with hemorrhagic fever with renal syndrome and acute biliary pancreatitis. Medicine (Baltimore) 2020; 99:e18916. [PMID: 32000399 PMCID: PMC7004732 DOI: 10.1097/md.0000000000018916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Acute pancreatitis (AP) is a rare complication of hemorrhagic fever with renal syndrome (HFRS), and is difficult to diagnose. In this study, we retrospectively analyzed the clinical characteristics of 7 cases of HFRS complicated with AP and 105 cases of acute biliary pancreatitis (ABP).Medical records of 83 hospitalized patients with HFRS and 105 hospitalized patients with ABP in the affiliated Yijishan Hospital of Wannan Medical College were reviewed. The comparative analysis of patients between the 2 groups was conducted in terms of sex, age, duration of hospital stay, fever, hemorrhage, proteinuria, oliguria, laboratory results, radiologic examinations, and prognosis.A total of 83 patients were diagnosed with HFRS during study period. Only 8.43% (7/83) of the total HFRS patients were diagnosed with AP. The differences in the gender, age, and duration of hospital stay between the 2 investigated groups of patients were not statistically significant. The major symptoms for all 7 patients with HFRS complicated with AP and 105 patients with ABP were fever and upper abdominal pain. During the disease course of HFRS complicated with AP, 6 patients experienced hemorrhaging, and 7 patients underwent an oliguric stage, but none of the ABP patients experienced hemorrhaging and oliguria. Among the laboratory results of all patients, the differences in alanine aminotransferase and glycemia were not statistically significant. The other laboratory results (leucocyte count, platelet count, amylase, lipase, total bilirubin, direct bilirubin, creatinine, blood urea nitrogen, prothrombin time, activated partial thromboplastin time, and serum calcium level) were significantly different during hospitalization. All 7 patients with HFRS complicated with AP received conservative medical treatment and hemodialysis. In the patients with ABP, 21 patients were discharged from the hospital after conservative treatment, 53 patients were treated by endoscopic invasive treatment after stabilization, and 31 patients were treated by surgery after stabilization.AP is not a frequent complication in patients with HFRS. There are differences in clinical manifestations and laboratory findings between the HFRS complicated with AP group and the ABP group; these differences may help in the differential diagnosis and treatment of these 2 types of pancreatitis.
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Affiliation(s)
| | - Jing Zhao
- Department of Gastrointestinal Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China
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The "MICE" scoring system in differentiating the identical twins leptospirosis and hantavirus infection. Infection 2019; 48:99-107. [PMID: 31656011 DOI: 10.1007/s15010-019-01366-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. METHODS The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed ("MICE" score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the "MICE" scoring system. RESULTS Three cut-off values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/μL): ≤ 7500, 7500-15,000, and > 15,000; total bilirubin (mg/dL): ≤ 3, 3-10, and > 10; CRP (mg/dL): ≤ 5, 5-15, and > 15; creatinine (mg/dL): ≤ 1.5, 1.5-3, and > 3; CK (U/L): ≤ 500, 500-1000, > 1000. AUC was calculated as 0.964 at ROC analysis, while the most noteworthy cut-off point was obtained when MICE score was ≥ 3, exhibiting 93.5% sensitivity, 92.9% specificity, PPV 94.5% and NPV 91.5%. A test score ≥ 3 was regarded as positive. In addition, our patients were evaluated using other current scoring systems in addition to "MICE," and our scoring system exhibited a greater diagnostic power in our subjects. CONCLUSIONS Leptospirosis and hantavirus infections can be accurately predicted by the MICE scoring system. Early diagnosis and rational treatment will also help to lower the mortality rates in these diseases.
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Çelebi G, Öztoprak N, Öktem İMA, Heyman P, Lundkvist Å, Wahlström M, Köktürk F, Pişkin N. Dynamics of Puumala hantavirus outbreak in Black Sea Region, Turkey. Zoonoses Public Health 2019; 66:783-797. [PMID: 31293096 DOI: 10.1111/zph.12625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Some of the hantavirus species in Euro-Asia cause haemorrhagic fever with renal syndrome (HFRS) in humans. The first documented human hantavirus infection in Turkey was diagnosed in 2009. This report describes the dynamics of the first hantavirus outbreak that emerged in humans in the Western Black Sea Region of Turkey. METHODS All the suspected cases of hantavirus infection were admitted to the Infectious Diseases and Clinical Microbiology Department at the Zonguldak Bülent Ecevit University Hospital in Zonguldak, Turkey. The patients were carefully interviewed, examined and evaluated using routine laboratory tests and hantavirus diagnostic tools. Hantavirus-reactive antibodies (IgM and IgG) in serum samples were detected via enzyme immune assay (EIA) and immunofluorescence assay (IFA) in the acute and convalescence stages of the disease. The presence of hantavirus ribonucleic acid (RNA) was analysed via reverse transcription polymerase chain reaction (RT-PCR) in serum and urine samples. A focus reduction neutralization test (FRNT) was performed to confirm specific hantavirus serotypes. In addition, a case-control study was conducted to identify possible risk factors for hantavirus transmission in the outbreak area. A control group was composed of asymptomatic individuals who were seronegative for hantavirus IgM and IgG and living in the outbreak area. RESULTS A total of 55 suspected cases of hantavirus infection were admitted to the inpatient clinic between February and June of 2009. Twenty-four patients were diagnosed with acute HFRS via EIA or IFA. In 22 of the 24 infected patients, Puumala virus (PUUV) was identified as the causative hantavirus type by detecting IgM in the acute stage and an increase in the IgG level in follow-up serum samples. PUUV was also verified as the infecting agent by FRNT in two of the 24 cases. Among the 24 laboratory-confirmed HFRS cases, 21 (87.5%) were males and 3 (12.5%) were females, and the mean age was 45.92 years (standard deviation ± 16.90 years). Almost all these individuals were living in villages or rural areas. The 24 HFRS cases were matched with 26 healthy controls for statistical analyses and according to binary logistic regression analysis, and dealing with rodent control activities in gardens or in annexes of their homes (p = 0.021 and Odds ratio [OR] = 17.11) and being male (p = 0.019 and OR = 22.37) were detected as statistically significant risk factors for hantavirus infection. The most commonly observed clinical complaints were fatigue (95.8%), shivering (91.7%), fever (87.1%), headache (70.8%) and nausea (70.8%). Haemodialysis was required for four patients (16.7%). Except for the first case diagnosed with acute hantavirus infection, no patient died. The mean delay time to hospital admission from initiation of symptoms was 5.3 days, the mean duration of febrile days was 2.6 days, and the mean duration of hospital stay was 8.5 days. CONCLUSION Hantaviruses are circulating in Turkey and causing sporadic or epidemic infection in humans. Additional investigations are needed to better understand the dynamics of hantaviruses in this country.
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Affiliation(s)
- Güven Çelebi
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Nefise Öztoprak
- Department of Infectious Diseases and Clinical Microbiology, Antalya Educational and Research Hospital, Antalya, Turkey
| | | | - Paul Heyman
- Research Laboratory for Vector-Borne Diseases and Reference Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital, Brussels, Belgium
| | - Åke Lundkvist
- Department of Medical Biochemistry and Microbiology, Zoonosus Science Center, Uppsala University, Uppsala, Sweden
| | - Maria Wahlström
- Department of Medical Biochemistry and Microbiology, Zoonosus Science Center, Uppsala University, Uppsala, Sweden
| | - Fürüzan Köktürk
- Department of Biostatistics, Medical Faculty, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Nihal Pişkin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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Polat C, Sironen T, Plyusnina A, Karatas A, Sozen M, Matur F, Vapalahti O, Oktem IMA, Plyusnin A. Dobrava hantavirus variants found in
Apodemus flavicollis
mice in Kırklareli Province, Turkey. J Med Virol 2018; 90:810-818. [DOI: 10.1002/jmv.25036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/10/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Ceylan Polat
- Department of Medical Microbiology, Medical SchoolDokuz Eylül UniversityIzmirTurkey
| | - Tarja Sironen
- Department of VirologyUniversity of HelsinkiHelsinkiFinland
| | | | - Ahmet Karatas
- Department of Biology, Faculty of Arts and SciencesÖmer Halisdemir UniversityNiğdeTurkey
| | - Mustafa Sozen
- Department of Biology, Faculty of Arts and SciencesBülent Ecevit UniversityZonguldakTurkey
| | - Ferhat Matur
- Department of Biology, Faculty of Arts and SciencesBülent Ecevit UniversityZonguldakTurkey
| | - Olli Vapalahti
- Department of VirologyUniversity of HelsinkiHelsinkiFinland
| | - I. Mehmet Ali Oktem
- Department of Medical Microbiology, Medical SchoolDokuz Eylül UniversityIzmirTurkey
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Dandolo A, Prajs N, Lizop M. [Nephropathy due to Puumala hantavirus]. Arch Pediatr 2014; 21:1334-8. [PMID: 25449445 DOI: 10.1016/j.arcped.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/30/2014] [Accepted: 09/21/2014] [Indexed: 11/18/2022]
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is due to an infection by the virus of the Hantavirus genus. Rodent hosts of Hantavirus are present in restricted areas in France; consequently, there are ecological niches and microepidemics of human Hantavirus infections. A HFRS case was diagnosed in the Paris region. The 11-year-old child had an acute debut fever-persistent despite antipyretic medication-asthenia, headache, abdominal pain, myalgia, thrombocytopenia, as well as renal failure with proteinuria. The diagnosis was made with a relevant clinical history and the specific serology of Puumala hantavirus. Therefore, a kidney biopsy was not necessary. What was interesting was the diagnostic approach because of the difference between the place and time of contamination and where the child became ill and developed the symptoms. The child was infected by Puumala hantavirus in Les Ardennes, a high-risk area, but became ill in the Paris region, an area with no prevalence. We review Hantavirus infections in France and its differential diagnosis.
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Affiliation(s)
- A Dandolo
- Service des urgences, institut hospitalier Franco-Britannique, 92300 Levallois-Perret, France.
| | - N Prajs
- Service de pédiatrie, institut hospitalier Franco-Britannique, 92300 Levallois-Perret, France
| | - M Lizop
- Service de pédiatrie, institut hospitalier Franco-Britannique, 92300 Levallois-Perret, France
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Dvorscak L, Czuchlewski DR. Successful triage of suspected hantavirus cardiopulmonary syndrome by peripheral blood smear review: a decade of experience in an endemic region. Am J Clin Pathol 2014; 142:196-201. [PMID: 25015860 DOI: 10.1309/ajcpnfvwg46nuhed] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES In 2001, the University of New Mexico Hospitals implemented a rapid screening tool for the triage of suspected hantavirus cardiopulmonary syndrome based on peripheral blood smear morphology. Five criteria guided clinical decisions: thrombocytopenia, hemoconcentration, granulocytic left shift, absence of toxic changes, and more than 10% immunoblasts. Smears meeting four of five criteria were previously shown to have high predictive value for infection. Our retrospective study aimed to determine clinical performance of this test over the past decade. METHODS Computerized records of 188 smear results were compared with serology. RESULTS Receiver operator characteristic curve analysis confirmed that the four of five cutoff was the most clinically useful, with sensitivity and specificity of 89% and 93%, respectively. All patients meeting five of five criteria had confirmed infections. Fifteen discordant results were uncovered, explained by positive subsequent tests in the same patient or severe disease without further testing. CONCLUSIONS Our findings confirm that peripheral smear analysis is clinically useful in this endemic region.
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Affiliation(s)
- Lauren Dvorscak
- Department of Pathology, University of New Mexico, Albuquerque
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