1
|
Jamil Z, Khalid S, Khan HMMH, Waheed I, Ehsan A, Alissa M, Muhammad K, Munawar N, Waheed Y. Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Novel Score in Early Detection of Complicated Dengue Fever. J Multidiscip Healthc 2024; 17:2321-2330. [PMID: 38770172 PMCID: PMC11104365 DOI: 10.2147/jmdh.s459929] [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: 01/16/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The occurrence of dengue fever presents a considerable burden for public health care in developing countries. This study aims to validate APRI as predictor score for severity of dengue fever so that catastrophic events could be prevented, and early triage can save lives. Methods The retrospective cross-sectional study was done on dengue positive patients from August to November 2023. APRI score was calculated for every patient at the time of admission. The primary end-point was non-complicated disease (Simple dengue fever) vs complicated disease (dengue hemorrhagic fever and dengue shock syndrome). ROC curve was used to identify the role of APRI in prediction of dengue complication. Youden index was used to find the cut-off value of APRI along with sensitivity, specificity, positive and negative likelihood ratios. To further evaluate the role of APRI score, patients were divided into two groups, patients with APRI score greater and lesser than cut-off value. The qualitative variables among two groups were compared by chi-square testing. The predictors of complicated dengue were first determined by univariate regression analysis and then confirmed by multivariate regression analysis. Results The mean APRI score of 135 patients was 20.06 ± 6.31. AUC for APRI score was 0.93 (p < 0.0001) indicating that APRI score calculated at the time of admission is an excellent marker in determining the complicated dengue. The cut-off value for APRI score was 9.04 (sensitivity 84.91%, specificity 89.02%, p < 0.0001). The patients with APRI <9.04 mostly developed simple dengue fever (54.1%) vs DHF (4.4%) and DSS (1.5%), while patients with APRI >9.04 had more DHF (20.7%) and DSS (12.6%) vs simple dengue fever (6.7%). None of the patient died with APRI <9.04 while the mortality rate was 3.7% in patients with APRI >9.04. Conclusion The APRI score, calculated at the time of admission, is an excellent marker in determining the severe dengue.
Collapse
Affiliation(s)
- Zubia Jamil
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
| | - Samreen Khalid
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
| | | | - Ikram Waheed
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi, 43600, Pakistan
| | - Amna Ehsan
- Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi, 43600, Pakistan
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Khalid Muhammad
- Department of Biology, College of Science, UAE University, Al Ain, 15551, United Arab Emirates
| | - Nayla Munawar
- Department of Chemistry, College of Science, UAE University, Al Ain, 15551, United Arab Emirates
| | - Yasir Waheed
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, 1401, Lebanon
- MEU Research Unit, Middle East University, Amman, 11831, Jordan
| |
Collapse
|
2
|
Yadav A, Kumari P, Devi P, Adjele JJB, Budhiraja S, Tarai B, Pandey R. Dual RNA-Seq reveals transcriptionally active microbes (TAMs) dynamics in the serum of dengue patients associated with disease severity. Front Microbiol 2023; 14:1307859. [PMID: 38107870 PMCID: PMC10723774 DOI: 10.3389/fmicb.2023.1307859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Dengue virus (DENV) is a flavivirus that has emerged as a global health threat, characterized by either asymptomatic or mild self-limiting febrile illness, but a subset of DENV outbreaks have been associated with severe disease. Studies have looked into the host immune response and dengue viral load during infection. However, it remains unknown how the active microbial isolates modulate the dengue viral infection. In this study, we demonstrate the significance of in-depth analysis of microbiota composition in the serum samples of dengue-infected patients. Materials and methods RNA was extracted from the serum samples collected from 24 dengue positive patients. The human mapped reads generated through RNA-Sequencing (RNA-Seq) were removed, while the unmapped (non-human) reads were employed for microbial taxonomic classification using Kraken2 and Bracken2. Further, we assessed the initial blood parameters analyzing the complete blood count (CBC) profile of the patients. Results Findings revealed differential abundance of commensals and pathogenic microbes in the early febrile period of hospitalized dengue patients, segregated into, High Viral Reads (HVR) and Low Viral Reads (LVR). The Campylobacter genus was abundant in the HVR whereas Lactobacillus dominated the LVR patients. At species level, the microbiota of HVR exhibited higher abundance of unique potential opportunistic microbes, compared to the commensal microbes' enrichment in the LVR patients'. We hypothesize that the DENV might alter the microbiota composition as observed by the increase in preponderance of opportunistic pathogens and an absence of commensals in the HVR. The presence of commensals in the LVR might explain, i) overall lower dengue viral reads compared to the HVR, and ii) shift in lymphocytes (high) and neutrophils (low) counts; resulting in a comparatively milder clinical manifestation in this group. Our findings may help in understanding the co-infection aspect that will be important to develop dengue therapeutics and vaccines. Discussion This study highlights the potential of the unexplored roles of the TAMs in modulating the dengue disease severity using the metatranscriptomic sequencing. This study serves to enhance our understanding of the distinctive microbial and hematologic signatures in the early infection stage that differentiate patients with high viral reads patients from those with low dengue viral reads.
Collapse
Affiliation(s)
- Aanchal Yadav
- Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Pallawi Kumari
- Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Indraprastha Institute of Information Technology Delhi, New Delhi, India
| | - Priti Devi
- Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Jorelle Jeanne B. Adjele
- Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Centre for Food, Food Security, and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Sandeep Budhiraja
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, Delhi, India
| | - Bansidhar Tarai
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Max Healthcare, Delhi, India
| | - Rajesh Pandey
- Division of Immunology and Infectious Disease Biology, INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| |
Collapse
|
3
|
Moallemi S, Lloyd AR, Rodrigo C. Early biomarkers for prediction of severe manifestations of dengue fever: a systematic review and a meta-analysis. Sci Rep 2023; 13:17485. [PMID: 37838744 PMCID: PMC10576797 DOI: 10.1038/s41598-023-44559-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
Early identification of dengue patients at risk of adverse outcomes is important to prevent hospital overcrowding in low- to middle- income countries during epidemics. We performed a systematic review to identify which biomarkers measured in first 96 h of fever could predict dengue haemorrhagic fever (DHF, World Health Organization 1997 clinical classification) or severe dengue (SD, WHO 2009, clinical classification). PubMed, Scopus, CINAHL, Web of Science, and EMBASE databases were searched for prospective cohort and nested case-control studies published from 1997 to Feb 27, 2022. The protocol for the study was registered in PROSPERO (ID: CRD42021230053). After screening 6747 publications, and analysing 37 eligible studies reporting on 5925 patients, elevated C-reactive protein, aspartate aminotransferase, interleukin-8 and decreased albumin levels were strongly associated with dengue haemorrhagic fever (by meta-analyses of multiple studies, p < 0.05), while elevated vascular cell adhesion protein 1, syndecan-1, aspartate aminotransferase and C-reactive protein levels were strongly associated with severe dengue (by meta-analyses of multiple studies, p < 0.05). Further 44 and 28 biomarkers were associated with the risk of DHF and SD respectively, but only in a single study. The meta-analyses suggest the importance of early acute inflammation with hepatic involvement in determining the subsequent course of illness in dengue.
Collapse
Affiliation(s)
- Samaneh Moallemi
- School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, 2052, Australia
- Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Andrew R Lloyd
- Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Chaturaka Rodrigo
- School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
- Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| |
Collapse
|
4
|
Odio CD, Sánchez-González L, Delorey M, Adams LE, Jones ES, Lorenzi O, Munoz-Jordan J, Rivera-Amill V, Paz–Bailey G. The Effect of Age on Dengue Presentation and the Diagnostic Accuracy of the 2015 Pan American Health Organization Case Criteria in a Puerto Rican Cohort. Open Forum Infect Dis 2023; 10:ofad373. [PMID: 37663092 PMCID: PMC10468746 DOI: 10.1093/ofid/ofad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Background We evaluated dengue presentation by age, the performance of the 2015 Pan American Health Organization (PAHO) case criteria in identifying dengue cases, and variables to improve specificity. Methods Patients with fever ≤7 days (N = 10 408) were recruited from 2 emergency departments from May 2012 through December 2015. Serum samples were tested for dengue, chikungunya, and nasopharyngeal swabs for respiratory viruses. Smoothing splines assessed differences in the frequencies of signs/symptoms by age. Least absolute shrinkage and selection operator regressions identified the variables that best predicted dengue. Results Among 985 dengue cases, children aged <5 years were least likely to have leukopenia, but most likely to have rash and petechiae. Adults had the highest odds of aches/pains and headaches/retro-orbital pain. The 2015 PAHO criteria had sensitivity of 93% and specificity of 25%. Specificity could be improved by requiring at least 2 of the following criteria: vomiting/nausea, petechiae, rash, or leukopenia (specificity 68%, sensitivity 71%) or by using 2015 PAHO criteria plus either (1) aspartate aminotransferase >50 IU/L or platelet count <100 000 platelets/μL (specificity 81%, sensitivity 56%) or (2) itchy skin or absence of rhinorrhea or cough (specificity 51%, sensitivity 82%). Conclusions The 2015 PAHO dengue case criteria had excellent sensitivity but poor specificity. This can be improved by adding signs/symptoms associated with dengue diagnosis.
Collapse
Affiliation(s)
- Camila D Odio
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Liliana Sánchez-González
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Mark Delorey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention,Fort Collins, Colorado
| | - Laura E Adams
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Emma S Jones
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention,Fort Collins, Colorado
| | - Olga Lorenzi
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | - Jorge Munoz-Jordan
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| | | | - Gabriela Paz–Bailey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bethesda, Maryland 20814, USA
| |
Collapse
|
5
|
Maduranga S, Valencia BM, Sigera C, Adikari T, Weeratunga P, Fernando D, Rajapakse S, Lloyd AR, Bull RA, Rodrigo C. Genomic Surveillance of Recent Dengue Outbreaks in Colombo, Sri Lanka. Viruses 2023; 15:1408. [PMID: 37515097 PMCID: PMC10384240 DOI: 10.3390/v15071408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
All four serotypes of the dengue virus (DENV1-4) cause a phenotypically similar illness, but serial infections from different serotypes increase the risk of severe disease. Thus, genomic surveillance of circulating viruses is important to detect serotype switches that precede community outbreaks of disproportionate magnitude. A phylogenetic analysis was conducted on near full length DENV genomes sequenced from serum collected from a prospective cohort study from the Colombo district, Sri Lanka during a 28-month period using Oxford nanopore technology, and the consensus sequences were analyzed using maximum likelihood and Bayesian evolutionary analysis. From 523 patients, 328 DENV sequences were successfully generated (DENV1: 43, DENV2: 219, DENV3:66). Most circulating sequences originated from a common ancestor that was estimated to have existed from around 2010 for DENV2 and around 2015/2016 for DENV1 and DENV3. Four distinct outbreaks coinciding with monsoon rain seasons were identified during the observation period mostly driven by DENV2 cosmopolitan genotype, except for a large outbreak in 2019 contributed by DENV3 genotype I. This serotype switch did not result in a more clinically severe illness. Phylogeographic analyses showed that all outbreaks started within Colombo city and then spread to the rest of the district. In 2019, DENV3 genotype I, previously, rarely reported in Sri Lanka, is likely to have contributed to a disease outbreak. However, this did not result in more severe disease in those infected, probably due to pre-existing DENV3 immunity in the community. Targeted vector control within Colombo city before anticipated seasonal outbreaks may help to limit the geographic spread of outbreaks.
Collapse
Affiliation(s)
- Sachith Maduranga
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - Chathurani Sigera
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Thiruni Adikari
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - Deepika Fernando
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Senaka Rajapakse
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Andrew R Lloyd
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Rowena A Bull
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Chaturaka Rodrigo
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| |
Collapse
|
6
|
Zargari Marandi R, Leung P, Sigera C, Murray DD, Weeratunga P, Fernando D, Rodrigo C, Rajapakse S, MacPherson CR. Development of a machine learning model for early prediction of plasma leakage in suspected dengue patients. PLoS Negl Trop Dis 2023; 17:e0010758. [PMID: 36913411 PMCID: PMC10035900 DOI: 10.1371/journal.pntd.0010758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/23/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND At least a third of dengue patients develop plasma leakage with increased risk of life-threatening complications. Predicting plasma leakage using laboratory parameters obtained in early infection as means of triaging patients for hospital admission is important for resource-limited settings. METHODS A Sri Lankan cohort including 4,768 instances of clinical data from N = 877 patients (60.3% patients with confirmed dengue infection) recorded in the first 96 hours of fever was considered. After excluding incomplete instances, the dataset was randomly split into a development and a test set with 374 (70%) and 172 (30%) patients, respectively. From the development set, five most informative features were selected using the minimum description length (MDL) algorithm. Random forest and light gradient boosting machine (LightGBM) were used to develop a classification model using the development set based on nested cross validation. An ensemble of the learners via average stacking was used as the final model to predict plasma leakage. RESULTS Lymphocyte count, haemoglobin, haematocrit, age, and aspartate aminotransferase were the most informative features to predict plasma leakage. The final model achieved the area under the receiver operating characteristics curve, AUC = 0.80 with positive predictive value, PPV = 76.9%, negative predictive value, NPV = 72.5%, specificity = 87.9%, and sensitivity = 54.8% on the test set. CONCLUSION The early predictors of plasma leakage identified in this study are similar to those identified in several prior studies that used non-machine learning based methods. However, our observations strengthen the evidence base for these predictors by showing their relevance even when individual data points, missing data and non-linear associations were considered. Testing the model on different populations using these low-cost observations would identify further strengths and limitations of the presented model.
Collapse
Affiliation(s)
- Ramtin Zargari Marandi
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Preston Leung
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Daniel Dawson Murray
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Chaturaka Rodrigo
- Viral Immunology Systems Program (VISP), Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Cameron Ross MacPherson
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
Effect of prior Zika and dengue virus exposure on the severity of a subsequent dengue infection in adults. Sci Rep 2022; 12:17225. [PMID: 36241869 PMCID: PMC9568574 DOI: 10.1038/s41598-022-22231-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/11/2022] [Indexed: 01/06/2023] Open
Abstract
Given the structural similarity between Zika and dengue viruses, prior infection from one virus is hypothesized to modulate the severity of a subsequent infection from the other virus. A previous paediatric cohort study observed that a prior Zika infection may increase the risk of a subsequent symptomatic or severe dengue infection. The Colombo Dengue study is a prospective hospital-based cohort study in Sri Lanka that recruits symptomatic adult dengue patients within the first three days of fever. Anti-Dengue Envelope and anti-Zika NS1 IgG antibodies were tested by ELISA (Euroimmun, Lubeck, Germany) in all recruited patients. Associations between pre-morbid seroprevalence for either or both infections and adverse clinical outcomes of the current dengue infection were explored. A total of 507 dengue infected patients were assessed of whom 342 (68%) and 132 (26%) patients had anti-dengue IgG and anti-Zika IgG respectively. People with combined prior dengue and zika exposure as well as prior dengue exposure alone, were at increased risk of plasma leakage, compensated and uncompensated shock, and severe dengue (p < 0·05), compared to people without prior exposure to either infection. The effect of prior Zika exposure alone could not be established due to the small the number of primary dengue infections with prior Zika exposure.
Collapse
|
8
|
A molecular beacon biosensor for viral RNA detection based on HyCaSD strategy. Anal Chim Acta 2022; 1221:340134. [DOI: 10.1016/j.aca.2022.340134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022]
|
9
|
Rodrigo C, Sigera C, Fernando D, Rajapakse S. Plasma leakage in dengue: a systematic review of prospective observational studies. BMC Infect Dis 2021; 21:1082. [PMID: 34670495 PMCID: PMC8527656 DOI: 10.1186/s12879-021-06793-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Plasma leakage is a precursor to life-threatening complications of dengue, but this group is poorly defined and not often reported in literature. Patients with Dengue haemorrhagic fever (DHF) as defined in the 1997 World Health Organization classification are often reported, and they all have plasma leakage, but some patients with plasma leakage do not meet the definition of DHF. The study aims to estimate the frequency of plasma leakage and DHF (as a surrogate of plasma leakage) in dengue and its variations based on virus serotype, geography, patient gender and pre-existing immunity to dengue. PUBMED, Scopus, EMBASE, CINAHL and Web of Science were searched for prospective observational studies reporting on plasma leakage or DHF. Quality of data was assessed using the NIH quality assessment tool for cohort studies. Forty-three studies that recruited 15,794 confirmed dengue patients were eligible. Cumulative frequency of plasma leakage was 36.8% (15 studies, 1642/4462, 95% CI 35.4-38.2%), but surprisingly the estimated cumulative frequency of DHF was higher (45.7%, 32 studies, 4758/10417, 95% CI 44.7-46.6%), indicating that current medical literature over-reports DHF or under-reports plasma leakage. Therefore, a reliable estimate for the proportion of dengue patients developing plasma leakage cannot be derived from existing medical literature even after applying rigorous inclusion criteria to select homogenous studies. Plasma leakage is an important marker of "at-risk" dengue patients and standardizing its definition, diagnosis and reporting should be a priority in research and global policy.
Collapse
Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia.
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| |
Collapse
|
10
|
Turuk J, Palo SK, Rath S, Subhadra S, Sabat J, Sahoo PK, Panda S, Pati S. Viral characteristics and clinical presentation in dengue co-infection- Findings from a facility based observational study in Odisha, India. J Family Med Prim Care 2021; 10:2958-2963. [PMID: 34660431 PMCID: PMC8483126 DOI: 10.4103/jfmpc.jfmpc_2380_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Dengue has affected many countries globally. Two-fifths part of the world is at risk, which can be affected by dengue disease. In India, the dengue incidence has increased in the recent past and emerged as an important health problem in many states including Odisha. Dengue disease presents with atypical clinical symptoms when associated with other co-infections. Materials and Methods: A facility-based longitudinal study was carried out over a period of 1 year to determine the dengue co-infection and its outcome. The suspected cases were clinically assessed following a standard case report format and serological investigations including serotyping were carried out. Results: 33.6% samples were dengue positive of which 78.5% were positive for NS1 Ag, 26.6% positive for dengue IgM and 5.1% to both. Among the dengue positive cases, 60.9% were male and mean age was 31.52 (±17.03) years. High occurrence of cases was during May to November with maximum in August. Among the 975 dengue positives, 57 (5.8%) were found to have co-infection. Chikungunya was the most common co-infection in 71.9%, followed by herpes simplex (HSV) (7%) and other diseases. Fever was the most common presenting symptom (98.2%), followed by myalgia (91.2%), retro orbital pain (91.2%), pain abdomen (12.3%), rash/lesion (8.8%), burning micturition (5.3%), petechiae (1.7%) and pruritus (1.7%) among the co-infected cases. Conclusions: All the four dengue serotypes were found to be circulating with DEN 2 as the most predominant one. About 5.8% of dengue cases have co-infection (mainly with Chikungunya) and clinically present with atypical signs and symptoms.
Collapse
Affiliation(s)
| | - Subrata K Palo
- Department of Public Health, ICMR-RMRC Bhubaneswar, Odisha, India
| | - Sonalika Rath
- VRDL, ICMR-RMRC Bhubaneswar, Nalco Square, Odisha, India
| | | | | | | | | | | |
Collapse
|
11
|
Sigera C, Rodrigo C, de Silva NL, Weeratunga P, Fernando D, Rajapakse S. Direct costs of managing in-ward dengue patients in Sri Lanka: A prospective study. PLoS One 2021; 16:e0258388. [PMID: 34624062 PMCID: PMC8500425 DOI: 10.1371/journal.pone.0258388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential. OBJECTIVE To characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka. METHODS Colombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios. RESULTS From October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients. CONCLUSION As non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.
Collapse
Affiliation(s)
- Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, Sydney, NSW, Australia
| | - Nipun L. de Silva
- Department of Clinical Sciences, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
12
|
Thach TQ, Eisa HG, Hmeda AB, Faraj H, Thuan TM, Abdelrahman MM, Awadallah MG, Ha NX, Noeske M, Abdul Aziz JM, Nam NH, Nile ME, Dumre SP, Huy NT, Hirayama K. Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009808. [PMID: 34610027 PMCID: PMC8519480 DOI: 10.1371/journal.pntd.0009808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 10/15/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. METHODOLOGY We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). PRINCIPAL FINDINGS Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. CONCLUSION The findings suggest that alterations of platelet count and AST level-in the first 72 hours of fever onset-are independent markers predicting the development of severe dengue.
Collapse
Affiliation(s)
- Tran Quang Thach
- Department of Immunogenetics, Nagasaki University, Nagasaki, Japan
| | - Heba Gamal Eisa
- Faculty of Medicine, Menoufia University, Shebin El-Koum, Egypt
| | | | - Hazem Faraj
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Tieu Minh Thuan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Nam Xuan Ha
- Hue University of Medicine and Pharmacy, Hue, Vietnam
| | - Michael Noeske
- American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | | | - Nguyen Hai Nam
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
13
|
Goarant C, Dellagi K, Picardeau M. Ending the Neglect of Treatable Bacterial Zoonoses Responsible for Non-Malaria Fevers. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:351-360. [PMID: 34211354 PMCID: PMC8223548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bacterial zoonotic diseases such as leptospirosis, Q fever, melioidosis, spotted
fever group rickettsioses, and brucellosis are increasingly recognized causes of
non-malaria acute fevers. However, though readily treatable with antibiotics,
these diseases are commonly misdiagnosed resulting in poor outcomes in patients.
There is a considerable deficit in the understanding of basic aspects of the
epidemiology of these neglected diseases and diagnostic tests for these zoonotic
bacterial pathogens are not always available in resource-poor settings. Raising
awareness about these emerging bacterial zoonoses is directly beneficial to the
patients by allowing a test-and-treat approach and is essential to control these
life-threatening diseases.
Collapse
Affiliation(s)
- Cyrille Goarant
- Institut Pasteur de Nouvelle-Calédonie, Unité de Recherche et d'Expertise sur la Leptospirose, Nouméa, New Caledonia
| | | | | |
Collapse
|
14
|
Sigera PC, Rajapakse S, Weeratunga P, De Silva NL, Gomes L, Malavige GN, Rodrigo C, Fernando SD. Dengue and post-infection fatigue: findings from a prospective cohort-the Colombo Dengue Study. Trans R Soc Trop Med Hyg 2021; 115:669-676. [PMID: 33099653 DOI: 10.1093/trstmh/traa110] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Previous studies on post-infection fatigue in dengue are few but suggest that up to 25% of dengue patients may suffer from fatigue. This study aimed to evaluate the prevalence and associations of post-infection fatigue in dengue patients compared with non-dengue fever patients. METHODS Post-infection fatigue and its demographic and clinical associations were assessed in adult dengue and non-dengue fever patients 2 months after the acute infection in a prospective cohort study in Sri Lanka. Fatigue at 2 months (primary endpoint) was assessed with the fatigue questionnaire as a dichotomous outcome based on a pre-recommended cut-off (score ≥4) and as the total score from the questionnaire (higher score indicates more fatigue). RESULTS Of 260 patients, 158 had dengue and, of these, 51 (32%) had fatigue at 2 months. Risk was higher in dengue patients (vs non-dengue; relative risk [RR] 4.93 [95% confidence interval {CI} 2.3 to 10.4]) and more so in female dengue patients (vs male dengue patients; RR 2.45 [95% CI 1.24 to 4.86]). Severe dengue patients had a higher mean fatigue score (p=0.024). CONCLUSIONS Post-infection fatigue is an underappreciated burden of this widely prevalent infection. Our findings are useful to triage patients at risk of fatigue for follow-up.
Collapse
Affiliation(s)
- Ponsuge C Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| | - Nipun L De Silva
- Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, 10390, Ratmalana, Sri Lanka
| | - Laksiri Gomes
- Centre for Dengue Research, Faculty of Medical Sciences, University of Sri Jayewardenepura, 10250, Nugegoda, Sri Lanka
| | - Gathsaurie N Malavige
- Centre for Dengue Research, Faculty of Medical Sciences, University of Sri Jayewardenepura, 10250, Nugegoda, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sumadhya D Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, 00800, Colombo 08, Sri Lanka
| |
Collapse
|
15
|
Sigera PC, Weeratunga P, Deepika Fernando S, Lakshitha De Silva N, Rodrigo C, Rajapakse S. Rational use of ultrasonography with triaging of patients to detect dengue plasma leakage in resource limited settings: a prospective cohort study. Trop Med Int Health 2021; 26:993-1001. [PMID: 33892519 DOI: 10.1111/tmi.13594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare the traditional haematocrit-based criteria (>20% rise above baseline) with ultrasonography for diagnosing plasma leakage in dengue fever and to identify clinical indicators for triaging patients in resource-limited settings when the demand for ultrasonography is high. METHODS The Colombo Dengue Study is a prospective observational cohort study recruiting dengue patients in the first three days of dengue fever, before plasma leakage. Serial haematocrit assessments and ultrasonography were performed in patients recruited from October 2017 to February 2020. Clinical signs/symptoms and laboratory investigation results independently associated with ultrasound detected plasma leakage were identified with a derivation cohort and confirmed in a validation cohort. RESULTS 129 of 426 patients had ultrasonography-confirmed plasma leakage while 146 had a haematocrit rise >20%. Those positive on ultrasonography were also likely to fulfil the haematocrit-based criteria (OR: 4.42, 95% CI: 2.85-6.86), but the two groups did not overlap fully. In the derivation cohort (n = 317), platelet count <97 000/µl, AST/ALT > 51 IU/l and having abdominal pain in the first three days of fever were independent predictors of ultrasound-detected plasma leakage. In the validation cohort (n = 109), the combination of low platelet count and high aminotransferase level had better predictive capacity in terms of sensitivity and specificity. CONCLUSION Dengue patients should be monitored with both serial haematocrit and ultrasonography whenever possible and plasma leakage should be diagnosed by either one of these criteria. If accessibility to scans is limited, platelet count, serum transaminase levels and presence of abdominal pain are useful to triage patients.
Collapse
Affiliation(s)
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Nipun Lakshitha De Silva
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defense University, Ratmalana, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
16
|
Mohon AN, Oberding L, Hundt J, van Marle G, Pabbaraju K, Berenger BM, Lisboa L, Griener T, Czub M, Doolan C, Servellita V, Chiu CY, Greninger AL, Jerome KR, Pillai DR. Optimization and clinical validation of dual-target RT-LAMP for SARS-CoV-2. J Virol Methods 2020; 286:113972. [PMID: 32941977 PMCID: PMC7490281 DOI: 10.1016/j.jviromet.2020.113972] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023]
Abstract
A novel reverse-transcriptase loop mediated amplification (RT-LAMP) method targeting genes encoding the Spike (S) protein and RNA-dependent RNA polymerase (RdRP) of SARS-CoV-2 has been developed. The LAMP assay achieves a comparable limit of detection (25-50 copies per reaction) to commonly used RT-PCR protocols using clinical samples quantified by digital droplet PCR. Precision, cross-reactivity, inclusivity, and limit of detection studies were performed according to regulatory standards. Clinical validation of dual-target RT-LAMP (S and RdRP gene) achieved a PPA of 98.48 % (95 % CI 91.84%-99.96%) and NPA 100.00 % (95 % CI 93.84%-100.00%) based on the E gene and N2 gene reference RT-PCR methods. The method has implications for development of point of care technology using isothermal amplification.
Collapse
Affiliation(s)
- Abu Naser Mohon
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada
| | - Lisa Oberding
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada
| | - Jana Hundt
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada; Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Guido van Marle
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada
| | - Kanti Pabbaraju
- Alberta Public Health Laboratory, Alberta Precision Laboratory, Calgary, AB, Canada
| | - Byron M Berenger
- Alberta Public Health Laboratory, Alberta Precision Laboratory, Calgary, AB, Canada; Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada
| | - Luiz Lisboa
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada; Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas Griener
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada; Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Markus Czub
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Venice Servellita
- Department Pathology and Laboratory Medicine, University of California, San Francisco, USA
| | - Charles Y Chiu
- Department Pathology and Laboratory Medicine, University of California, San Francisco, USA
| | | | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dylan R Pillai
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada; Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada; Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada; Department of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
17
|
Adikari TN, Riaz N, Sigera C, Leung P, Valencia BM, Barton K, Smith MA, Bull RA, Li H, Luciani F, Weeratunga P, Thein TL, Lim VWX, Leo YS, Rajapakse S, Fink K, Lloyd AR, Fernando D, Rodrigo C. Single molecule, near full-length genome sequencing of dengue virus. Sci Rep 2020; 10:18196. [PMID: 33097792 PMCID: PMC7584602 DOI: 10.1038/s41598-020-75374-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/12/2020] [Indexed: 01/23/2023] Open
Abstract
Current methods for dengue virus (DENV) genome amplification, amplify parts of the genome in at least 5 overlapping segments and then combine the output to characterize a full genome. This process is laborious, costly and requires at least 10 primers per serotype, thus increasing the likelihood of PCR bias. We introduce an assay to amplify near full-length dengue virus genomes as intact molecules, sequence these amplicons with third generation “nanopore” technology without fragmenting and use the sequence data to differentiate within-host viral variants with a bioinformatics tool (Nano-Q). The new assay successfully generated near full-length amplicons from DENV serotypes 1, 2 and 3 samples which were sequenced with nanopore technology. Consensus DENV sequences generated by nanopore sequencing had over 99.5% pairwise sequence similarity to Illumina generated counterparts provided the coverage was > 100 with both platforms. Maximum likelihood phylogenetic trees generated from nanopore consensus sequences were able to reproduce the exact trees made from Illumina sequencing with a conservative 99% bootstrapping threshold (after 1000 replicates and 10% burn-in). Pairwise genetic distances of within host variants identified from the Nano-Q tool were less than that of between host variants, thus enabling the phylogenetic segregation of variants from the same host.
Collapse
Affiliation(s)
- Thiruni N Adikari
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Institute for Combinatorial Advanced Research and Education, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Nasir Riaz
- Kirby Institute, University of New South Wales, Sydney, Australia.,Department of Microbiology, Hazara University, Mansehra, KPK, Pakistan
| | - Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Preston Leung
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Kirston Barton
- Garvan Institute of Medical Research, Sydney, Australia and St-Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Martin A Smith
- Garvan Institute of Medical Research, Sydney, Australia and St-Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia.,CHU Sainte-Justine Research Centre, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Canada
| | - Rowena A Bull
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Hui Li
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Fabio Luciani
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Tun-Linn Thein
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Vanessa W X Lim
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Katja Fink
- Agency for Science, Technology and Research, Singapore, Singapore
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- School of Medical Sciences, University of New South Wales, Sydney, Australia. .,Kirby Institute, University of New South Wales, Sydney, Australia.
| |
Collapse
|
18
|
Doolan CP, Louie T, Lata C, Larios OE, Stokes W, Kim J, Brown K, Beck P, Deardon R, Pillai DR. Latent class analysis for the diagnosis of Clostridioides difficile infection. Clin Infect Dis 2020; 73:e2673-e2679. [PMID: 33053174 DOI: 10.1093/cid/ciaa1553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is an opportunistic disease that lacks a gold standard test. Nucleic acid amplification tests (NAATs) such as real-time PCR demonstrate excellent an limit of detection (LOD) whereas antigenic methods are able to detect free toxin. Latent class analysis (LCA) provides an unbiased statistical approach to resolving true disease. METHODS A cross-sectional study was conducted with suspected CDI patients (n=96). Four commercial real-time PCR tests, toxin antigen detection by enzyme immunoassay (EIA), toxigenic culture, and fecal calprotectin were performed. CDI clinical diagnosis was determined by consensus majority of three experts. LCA was performed using laboratory and clinical variables independent of any gold standard. RESULTS Six LCA models were generated to determine CDI probability using four variables including toxin EIA, toxigenic culture, clinical diagnosis, and fecal calprotectin levels. Three defined zones as a function of real-time PCR cycle threshold (Ct) were identified using LCA: CDI likely (>90% probability), equivocal (<90% and >10%), CDI unlikely (<10%). A single model comprising toxigenic culture, clinical diagnosis, and toxin EIA showed the best fitness. The following Ct cut-offs for four commercial test platforms were obtained using this model to delineate three CDI probability zones: [GeneXpert ® : 24.00, 33.61], [Simplexa ® 28.97, 36.85], [Elite MGB ® 30.18, 37.43], and [BD Max ™ 27.60, 34.26]. CONCLUSION The clinical implication of applying LCA to CDI is to report Ct values assigned to probability zones based on the commercial real-time PCR platform. A broad range of equivocation suggests clinical judgement is essential to the confirmation of CDI.
Collapse
Affiliation(s)
- Cody P Doolan
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas Louie
- Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Oscar E Larios
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - William Stokes
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Kim
- Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kristen Brown
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Beck
- Clinical Section of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob Deardon
- Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, AB, Canada.,Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Dylan R Pillai
- Clinical Section of Microbiology, Alberta Precision Laboratories, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, AB, Canada.,Department Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,Clinical Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
19
|
Identification of dengue patients with high risk of severe disease, using early clinical and laboratory features, in a resource-limited setting. Arch Virol 2020; 165:2029-2035. [DOI: 10.1007/s00705-020-04720-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
|
20
|
Noor R. Reemergence of dengue virus in Bangladesh: Current fatality and the required knowledge. Tzu Chi Med J 2019; 32:227-233. [PMID: 32955510 PMCID: PMC7485671 DOI: 10.4103/tcmj.tcmj_193_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/08/2022] Open
Abstract
The current fatality of dengue among the Bangladeshi population has drawn the interest of the public health professionals primarily to focus on the environmental, social, and clinical reasoning as well the possible remedies. This year, in 2019, the dengue situation in Bangladesh has appeared with all its dreadful effects leading to the highest death cases due to dengue virus (DENV) infection. According to the Directorate General of Health Services report, this year (2019) the number of DENV-infected people has appeared to be around five times higher (approximately 50,000 cases so far) compared with the last year, 2018 (around 10,000 cases). The present review discussed the current epidemics of dengue infection in Bangladesh as well the possible means of disease curing in terms of general preventive concepts. However, besides the precise treatment of the dengue-affected patients, the knowledge on DENV genome and on the protective immunity against such reemerging disease is essential.
Collapse
Affiliation(s)
- Rashed Noor
- Department of Microbiology, School of Life Sciences, Independent University, Dhaka, Bangladesh
| |
Collapse
|