Simple Clinical and Laboratory Predictors of Chikungunya versus Dengue Infections in Adults

Abstract

Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF), is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making. We compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR) with 917 dengue RT-PCR-positive adult patients (including 55 with DHF). We compared dengue fever (DF), DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables. At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF), nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets 9/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets 9/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable. There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management. Dengue and chikungunya are mosquito-borne diseases that are found in similar geographical areas and present with similar symptoms. As their treatment is different, especially for dengue haemorraghic fever (DHF) which is a more severe form of dengue, it is important for healthcare workers to differentiate between them. We studied 117 chikungunya and 917 dengue adult patients (including 55 with DHF) by comparing their clinical presentation and developed decision trees to classify them using simple symptoms and laboratory tests. From the study, we found that at their first appearance in hospital, more chikungunya patients had muscle or joint pains, and fewer had a sore throat, cough, nausea, vomiting, diarrhea, stomach pain, loss of appetite or fast heart beat than DF or DHF patients. From the decision trees, of DF versus chikungunya using only platelet level cut-offs, we could correctly classify 89% of the cases. For DHF versus chikungunya using platelet level cut-offs and the presence of bleeding, the correct classification was 98%. The use of these simple decision trees can therefore predict the subsequent development of these infections for appropriate treatment.