Simple Clinical and Laboratory Predictors of Chikungunya versus Dengue Infections in Adults 英文参考文献.docVIP

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Simple Clinical and Laboratory Predictors of Chikungunya versus Dengue Infections in Adults 英文参考文献.doc

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Simple Clinical and Laboratory Predictors of Chikungunya versus Dengue Infections in Adults 英文参考文献

SimpleClinicalandLaboratoryPredictorsof ChikungunyaversusDengueInfectionsinAdults VernonJ.Lee1,2*,AngelaChow1,XiaohuiZheng3,LuisR.Carrasco3,4,AlexR.Cook2,3,5,DavidC.Lye6, Lee-ChingNg7,Yee-SinLeo6 1Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore, 2Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Singapore,3DepartmentofStatisticsandAppliedProbability,NationalUniversityofSingapore,Singapore,Singapore,4DepartmentofBiologicalSciences, NationalUniversityofSingapore,Singapore,Singapore,5PrograminHealthServicesandSystemsResearch,Duke-NUSGraduateMedicalSchool,Singapore,Singapore, 6DepartmentofInfectiousDiseases,TanTockSengHospital,Singapore,Singapore,7EnvironmentalHealthInstitute,NationalEnvironmentAgency,Singapore,Singapore Abstract Background: Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations.Itisimportanttodifferentiatebetweenthemduringfirstpresentationastheirmanagement,especiallyfor denguehemorrhagicfever(DHF),isdifferent.ThisstudycomparestheirclinicalpresentationinSingaporeadultstoderive predictorstoassistdoctorsindiagnosticdecision-making. Methods:Wecompared117patientswithchikungunyainfectiondiagnosedwithreversetranscription-polymerasechain reaction(RT-PCR)with917dengueRT-PCR-positiveadultpatients(including55withDHF).Wecompareddenguefever(DF), DHF,andchikungunyainfectionsbyevaluatingclinicalcharacteristicsofdengueandchikungunya;developingclassification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors;andassessingthetimecourseofseveralclinicalvariables. Findings:Atfirstpresentationtohospital,significantlymorechikungunyapatientshadmyalgiaorarthralgia,andfewerhad asorethroat,cough(forDF),nausea,vomiting,diarrhea,abdominalpain,anorexiaortachycardiathanDForDHFpatients. From the decision trees, platelets ,1186109/L was the only distinguishing feature for DF ve