Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area.
Rio de Janeiro is a dengue-endemic city that experienced Zika and chikungunya epidemics between 2015 and 2019. Differential diagnosis is crucial for indicating adequate treatment and assessing prognosis and risk of death. This study aims to derive and validate a clinical rule for diagnosing chikungu...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0279970 |
| _version_ | 1797866839306403840 |
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| author | Raquel Pereira Batista Yara Hahr Marques Hökerberg Raquel de Vasconcellos Carvalhaes de Oliveira Sonia Regina Lambert Passos |
| author_facet | Raquel Pereira Batista Yara Hahr Marques Hökerberg Raquel de Vasconcellos Carvalhaes de Oliveira Sonia Regina Lambert Passos |
| author_sort | Raquel Pereira Batista |
| collection | DOAJ |
| description | Rio de Janeiro is a dengue-endemic city that experienced Zika and chikungunya epidemics between 2015 and 2019. Differential diagnosis is crucial for indicating adequate treatment and assessing prognosis and risk of death. This study aims to derive and validate a clinical rule for diagnosing chikungunya based on 3,214 suspected cases consecutively treated at primary and secondary health units of the sentinel surveillance system (up to 7 days from onset of symptoms) in Rio de Janeiro, Brazil. Of the total sample, 624 were chikungunya, 88 Zika, 51 dengue, and 2,451 were negative for all these arboviruses according to real-time polymerase chain reaction (RT-qPCR). The derived rule included fever (1 point), exanthema (1 point), myalgia (2 points), arthralgia or arthritis (2 points), and joint edema (2 points), providing an AUC (area under the receiver operator curve) = 0.695 (95% CI: 0.662-0.725). Scores of 4 points or more (validation sample) showed 74.3% sensitivity (69.0% - 79.2%) and 51.5% specificity (48.8% - 54.3%). Adding more symptoms improved the specificity at the expense of a lower sensitivity compared to definitions proposed by government agencies based on fever alone (European Center for Disease Control) or in combination with arthralgia (World Health Organization) or arthritis (Pan American Health Organization, Brazilian Ministry of Health). The proposed clinical rule offers a rapid, low-cost, easy-to-apply strategy to differentiate chikungunya fever from other arbovirus infections during epidemics. |
| first_indexed | 2024-04-09T23:30:43Z |
| format | Article |
| id | doaj.art-681aee7210c84089a5db9a6d9fa3329e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T23:30:43Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-681aee7210c84089a5db9a6d9fa3329e2023-03-21T05:31:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01181e027997010.1371/journal.pone.0279970Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area.Raquel Pereira BatistaYara Hahr Marques HökerbergRaquel de Vasconcellos Carvalhaes de OliveiraSonia Regina Lambert PassosRio de Janeiro is a dengue-endemic city that experienced Zika and chikungunya epidemics between 2015 and 2019. Differential diagnosis is crucial for indicating adequate treatment and assessing prognosis and risk of death. This study aims to derive and validate a clinical rule for diagnosing chikungunya based on 3,214 suspected cases consecutively treated at primary and secondary health units of the sentinel surveillance system (up to 7 days from onset of symptoms) in Rio de Janeiro, Brazil. Of the total sample, 624 were chikungunya, 88 Zika, 51 dengue, and 2,451 were negative for all these arboviruses according to real-time polymerase chain reaction (RT-qPCR). The derived rule included fever (1 point), exanthema (1 point), myalgia (2 points), arthralgia or arthritis (2 points), and joint edema (2 points), providing an AUC (area under the receiver operator curve) = 0.695 (95% CI: 0.662-0.725). Scores of 4 points or more (validation sample) showed 74.3% sensitivity (69.0% - 79.2%) and 51.5% specificity (48.8% - 54.3%). Adding more symptoms improved the specificity at the expense of a lower sensitivity compared to definitions proposed by government agencies based on fever alone (European Center for Disease Control) or in combination with arthralgia (World Health Organization) or arthritis (Pan American Health Organization, Brazilian Ministry of Health). The proposed clinical rule offers a rapid, low-cost, easy-to-apply strategy to differentiate chikungunya fever from other arbovirus infections during epidemics.https://doi.org/10.1371/journal.pone.0279970 |
| spellingShingle | Raquel Pereira Batista Yara Hahr Marques Hökerberg Raquel de Vasconcellos Carvalhaes de Oliveira Sonia Regina Lambert Passos Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. PLoS ONE |
| title | Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. |
| title_full | Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. |
| title_fullStr | Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. |
| title_full_unstemmed | Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. |
| title_short | Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. |
| title_sort | development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue endemic area |
| url | https://doi.org/10.1371/journal.pone.0279970 |
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