Abstract
BackgroundDengue fever (DF) and malaria are the two major public health concerns in tropical countries such as Thailand. Early differentiation between dengue and malaria could help clinicians to identify patients who should be closely monitored for signs of dengue hemorrhagic fever or severe malaria. This study aims to build knowledge on diagnostic markers that are used to discriminate between the infections, which frequently occur in malaria-endemic areas, such as the ones in Thailand.MethodsA retrospective study was conducted in Phop Phra Hospital, a hospital located in the Thailand-Burma border area, a malaria-endemic area, between 2013 and 2015. In brief, data on 336 patients infected with malaria were compared to data on 347 patients infected with DF.ResultsWhite blood cells, neutrophil, monocyte, eosinophil, neutrophil-lymphocyte ratio, and monocyte-lymphocyte ratio were significantly lower in patients with DF compared to patients with malaria (P < 0.0001). In contrast, red blood cells, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were significantly higher in patients with DF as compared to patients with malaria (P < 0.0001). A decision tree model revealed that using neutrophils, lymphocyte, MCHC, and gender was guided to discriminate between dengue and malaria infection.ConclusionThis study concluded that several hematological parameters were different for diagnosing DF and malaria. A decision tree model revealed that using neutrophils, lymphocyte, MCHC, and gender was guided to discriminate patients with dengue and malaria infection. In addition, using these markers will thus lead to early detection, diagnosis, and prompt treatment of these tropical diseases.
Highlights
Dengue fever (DF) and malaria are the two major public health concerns in tropical countries such as Thailand
The objective of this study was to identify clinical and laboratory features that can differentiate between patients infected with dengue and those infected with malaria, as well as to build knowledge about diagnostic markers used to discriminate DF from malaria, which both frequently occur in malaria-endemic areas
A significant difference relating to gender between the two groups was observed (P = 0.001, Odds ratio (OR) 95%Confidence interval (CI) = 0.59 [0.44–0.80])
Summary
Dengue fever (DF) and malaria are the two major public health concerns in tropical countries such as Thailand. Dengue fever (DF) and malaria are the two most common arthropod-borne diseases in tropical countries, especially in Southeast Asian regions, where their endemic areas greatly overlap [1, 2]. Dengue infection can range from a nonspecific febrile illness, as in DF, to a more severe illness with bleeding tendency, thrombocytopenia, and plasma leakage (dengue hemorrhagic fever, DHF) [7]. Clinical characteristics of DHF, such as bleeding and plasma leakage, are seen at a later stage of the febrile phase after the third or fourth day of fever. Patients are classified as having DHF, according to the WHO guidelines, based on all of the following four signs: fever, thrombocytopenia (platelet count < 100 000/μL), bleeding (positive tourniquet test or spontaneous bleeding), and plasma leakage (evidence of pleural effusion, ascites or ≥ 20% hemoconcentration) [8]
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