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Selected Publication:
Schaeffler, A.
Comparison of clinical and laboratory presentation between PCR confirmed H1N1 influenza infection, rapid diagnostic test confirmed dengue infection and blood smear confirmed plasmodium infection
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 81
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- Authors Med Uni Graz:
- Advisor:
- Flick Holger
- Krause Robert
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- Abstract:
- Aim: Returning Travelers frequently present acute febrile illnesses in emergency departments or infectious disease clinics. In this setting, common and important differential diagnoses are dengue-, influenza- and plasmodium infections. Due to the relative low sensitivity and specificity of dengue rapid diagnostic- and influenza tests in the early phase of the disease, it is sometimes difficult to confirm the diagnosis within the first days after the onset of symptoms. The aim of this study is to determine clinical and laboratory differences between dengue and H1N1 influenza infection. The benefit of this study would be, that patients could be treated early (e.g. with neuraminidase inhibitors) when symptoms first appear and preventive measures could be implemented at time. Methods: We reviewed 761 patients with PCR confirmed H1N1 influenza infection, RDT (rapid diagnostic test) confirmed dengue infection or blood smear confirmed plasmodium infection from the 1st of January 2005 to the 1st of June 2013. Data was evaluated from the electronic Styrian hospital network, MEDOCS. We compared patients with H1N1 influenza, dengue and malaria with regard to clinical presentation, laboratory parameters and preexisting underlying conditions. Results: A sudden onset was found in only 82% of H1N1 patients, in 95% of dengue patients and in 96% of malaria patients (p<0,015). Fever occurred in 93% of H1N1 patients, as well as in 93% of dengue patients and in 81% of malaria patients (p=0,038).H1N1 patients were more likely to present respiratory symptoms and signs like cough (73% versus 15% in dengue and 10% in malaria; p<0,0001), wheezing (14% versus none of either dengue or malaria patients, p<0,001), dyspnea (22% versus 4% of malaria patients and none of dengue patients; p<0,0001), thoracic pain (9% versus 4% of malaria and none of dengue patients) and rales (10% versus none of either dengue or malaria patients). Dengue patients were more likely to present with rash (36% compared to 3% in H1N1 and none in malaria; p<0,0001), diarrhea (44% versus 11% of H1N1 and 10% of malaria patients; p<0,0001) and abdominal pain (23% versus 6% of H1N1 and 6% of malaria patients; p=0,008). Regarding underlying diseases, only asthma bronchiale (10% of H1N1 versus 2% of malaria and none of dengue patients; p=0,026) and neurologic diseases (10% of H1N1 versus none of either dengue and malaria patients; p=0,009) were significantly different and more frequent in the influenza group. In respect to laboratory values, a significant difference was observed in the following parameters: leukocyte level of 6,74 G/l (IQR 5-8,61) in the H1N1 compared to 5,11 G/l (IQR 3,06-7,46) in the dengue and 5,86 G/l (IQR 4,52-6,94) in the malaria group (p=0,002); thrombocyte concentration of 92 G/l (IQR 65,00-115) in the malaria compared to 204 G/l (IQR 166-243) in the H1N1 and 172 G/l (IQR 118-229) in the dengue group (p<0,0001); CRP level of 98,7 mg/l (IQR 55,95-152,5) in the malaria compared to 17,4 mg/l (IQR 5,5-43,5) in the H1N1 and 13 mg/l (IQR 3 -36,2) in the dengue (p<0,0001). Summary: Sudden onset of disease seems to appear as frequent in malaria and dengue infections as in influenza diseases and is therefore not a useful criterion for differentiation between these diseases. Respiratory symptoms such as cough, wheezing, dyspnea and thoracic pain are much more likely to occur in H1N1 patients and are rarely observed in dengue and malaria patients. Diarrhea and abdominal pain seem to be relatively specific for dengue infections.Leukopenia occurs in all three groups and is not a useful criterion for differentiation. If the thrombocyte level is lower than 160 G/l the diagnosis of malaria and dengue is more likely.H1N1 or dengue infections are more improbable if CRP is above 50 mg/l. Presented data may help for early differentiation between H1N1, dengue and malaria infections. However, the standard diagnostic procedures are still essential.