Dificultad para el diagnóstico clínico temprano del dengue en un área endémica y su impacto sobre el manejo médico inicial

Abstract

Early detection of dengue could help to prevent its complications. The usefulness of clinical criteria for diagnosis of the disease must be ascertained.To assess the correlation between laboratory and clinical diagnosis of dengue, done during the first consultation in the emergency room. To estimate the impact of clinical diagnosis on the initial medical treatment.Patients older than 5 years with an acute febrile syndrome that consulted during the first 72 hours of disease, during 2004, at an emergency room in Bucaramanga, Colombia, were studied. Symptoms and the clinical diagnosis of the initial evaluation were registered. Paired serum samples for dengue specific ELISA-IgM test and viral isolation were obtained. The association of the initial clinical diagnosis with early symptoms, initial medical treatment and laboratory diagnosis was evaluated.One hundred sixty eight patients were enrolled (54 with confirmed dengue infection). Clinical diagnosis of dengue was associated to a higher request of complete blood counts (p = 0.01) and greater use of intravenous fluids (p = 0.02). However, clinical diagnosis was not correlated with the laboratory diagnosis (p = 0.15). The percentage of agreement was less than would be expected by chance (Kappa = -0.1). Headache was associated to the initial clinical diagnosis of dengue (p = 0.03), and only metrorrhagia was associated with confirmed dengue infection (p = 0.04).The early clinical suspicion of dengue has a low concordance with the laboratory confirmation of the disease.