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Rojas EM, Herrera VM, Miranda MC, Rojas DP, Gómez AM, Pallares C, Cobos SM, Pardo L, Gélvez M, Páez A, Mantilla JC, Bonelo A, Parra E, Villar LA. Clinical Indicators of Fatal Dengue in Two Endemic Areas of Colombia: A Hospital-Based Case-Control Study. Am J Trop Med Hyg 2019; 100:411-419. [PMID: 30652671 PMCID: PMC6367622 DOI: 10.4269/ajtmh.17-0323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/14/2018] [Indexed: 12/19/2022] Open
Abstract
According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1:2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.
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Affiliation(s)
- Elsa M. Rojas
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
- Info Vida, Bucaramanga, Colombia
| | - Víctor M. Herrera
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - María C. Miranda
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - Diana Patricia Rojas
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Adriana M. Gómez
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | | | | | | | - Margarita Gélvez
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - Andrés Páez
- Instituto Nacional de Salud, Bogotá, Colombia
| | - Julio C. Mantilla
- Department of Pathology, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
| | - Anilza Bonelo
- Emerging Viruses and Disease-VIREM, Universidad del Valle, Cali, Colombia
| | - Edgar Parra
- Instituto Nacional de Salud, Bogotá, Colombia
| | - Luis A. Villar
- Center for Epidemiological Research, Universidad Industrial de Santander-UIS, Bucaramanga, Colombia
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Carabali M, Lim JK, Palencia DC, Lozano-Parra A, Gelvez RM, Lee KS, Florez JP, Herrera VM, Kaufman JS, Rojas EM, Villar LA. Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia. Trop Med Int Health 2018; 23:1231-1241. [PMID: 30176107 PMCID: PMC6334506 DOI: 10.1111/tmi.13147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To estimate the age‐specific incidence of symptomatic dengue and chikungunya in Colombia. Method A passive facility‐based fever surveillance study was conducted among individuals with undifferentiated fever. Confirmatory diagnostics included serological and molecular tests in paired samples, and surveillance's underreporting was assessed using capture–recapture methods. Results Of 839 febrile participants 686 completed the study. There were 33.2% (295/839) dengue infections (51% primary infections), and 35.9% (191/532) of negative dengue cases there were chikungunya cases. On average, dengue cases were younger (median = 18 years) than chikungunya cases (median = 25 years). Thrombocytopaenia and abdominal pain were the main dengue predictors, while presence of rash was the main predictor for chikungunya diagnosis. Underreporting of dengue was 31%; the estimated expansion factors indicate an underreporting rate of dengue cases of threefold for all cases and of almost sixfold for inpatients. Conclusions These findings highlight the ongoing coexistence of both arboviruses, a distinct clinical profile of each condition in the study area that could be used by clinicians to generate a differential diagnosis, and the presence of underreporting, mostly among hospitalised cases.
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Affiliation(s)
- Mabel Carabali
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Seoul, Korea.,McGill University, Montreal, QC, Canada
| | - Jacqueline K Lim
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Seoul, Korea
| | | | | | | | - Kang Sung Lee
- Global Dengue and Aedes-transmitted Diseases Consortium, International Vaccine Institute, Seoul, Korea
| | | | | | | | - Elsa M Rojas
- Universidad Industrial de Santander, Bucaramanga, Colombia
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Cardenas R, Sandoval CM, Rodriguez-Morales AJ, Bendezu H, Gonzalez A, Briceño A, De-La-Paz-Pineda J, Rojas EM, Scorza JV. Epidemiology of American tegumentary leishmaniasis in domestic dogs in an endemic zone of western Venezuela. Bull Soc Pathol Exot 2006; 99:355-8. [PMID: 17253053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Domestic dogs are not only reservoir hosts of the American zoonotic visceral leishmaniasis (ZVL) but of the American zoonotic tegumentary leishmaniasis (ATL) as well, for different reasons. However it is still controversial to state that dogs are incriminated as ATL reservoir hosts as there is evidence that humans and dogs are likely to be exposed in the same way to sandfly vector. In Venezuela this issue has not been completely addressed, for this reason we selected a location inside Trujillo city to study eco-epidemiological conditions as well as to survey a significant sample of dogs by Montenegro Skin Test (MST). Antigen was prepared according to standard procedure using Leishmania (V) braziliensis promastigotes (80 microg/ml); response was read 48 hours post-inoculation with an induration size > 5 mm being considered as positive. The study place is an endemic mountainous semi-urban area located at 850-950 masl with an average rainfall of 150 mm/year. We evaluated 61 dogs in 46 houses with 168 human beings. Among the human population 27 cases of ATL were reported (16.1%). With the MST we found 19 positive-reaction dogs (31%) (mean MST size of 9.58 mm, 95% CI: 8.41-10.75) in 13 houses (28%). Multivariate analysis did not reveal significant association between domestic MST positive-dog ownership and human ATL cases (RR = 1.48, p = 0.28). Although some studies have indicated that dog ownership and dog infection rates are associated with an increased risk of human disease in different evaluated places, this question has not been completely answered in Venezuelan studied zones, further research is necessary.
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Affiliation(s)
- R Cardenas
- Experimental Institute Jose-Witremundo-Torrealba, Universidad de Los Andes, Trujillo, Venezuela
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