Validation of clinical and epidemiological diagnosis criterion for confirming cholera

Fernando De A Pedrosa,Ricardo Arraes De A Ximenes

doi:10.1590/s0034-89102003000300005

Abstract

To validate the clinical and epidemiological diagnosis criterion for confirming cholera suspect cases. The study comprised 2,687 and 716 patients admitted with diarrhea to a public hospital in Macei , Brazil, in 1992 and 1997 respectively. Culture of V. cholerae O1 (Koch, 1884) in TCBS-agar was performed and the clinical and epidemiological criterion was applied and compared to the gold standard. The statistical analysis was carried out in two age-groups: less than five years old and five years old or more. There were studied 833 patients, of which 517 in 1992 and 316 in 1997; 72 aged less than five years and 761 aged five years or more. In those aged less than five years in 1992, sensitivity was 40% and specificity 84.6%. For this same age-group in 1997, sensitivity was 28.6% and specificity 62.5%. In patients aged five years or more in 1992, sensitivity was 99% and specificity 1.2%. For this same age-group in 1997, sensitivity was 86.9% and specificity 8.7%. The higher sensitivity of the clinical and epidemiological cholera diagnosis criterion in patients aged five years or more found in the study support its application during epidemics periods. In periods of lower incidence, all cases need to be confirmed using laboratory methods.

Highlights

The higher sensitivity of the clinical and epidemiological cholera diagnosis criterion in patients aged five years or more found in the study support its application during epidemics periods
Observando o valor preditivo positivo dos pacientes com idade igual ou superior a cinco anos, nota-se que seu valor, em 1992, foi bastante elevado (81,9%), sofrendo decréscimo (54,5%) em 1997, refletindo a magnitude da epidemia em 1992, caracterizada pela elevada prevalência, diferentemente do ocorrido no ano de 1997

Summary

Introduction

No Brasil, o critério de definição de casos adotado pelo Ministério da Saúde[4] (1994) é o laboratorial pelo isolamento do V. cholerae patogênico (O1 e O139) e o clínico-epidemiológico, que alia, além dos dados de sinais e sintomas, aspectos epidemiológicos, como procedência, idade e ocorrência de cólera, confirmada em laboratório de pacientes ou ambiente em área comum. A população de estudo foi composta de pacientes atendidos em um hospital, com quadro clínico de diarréia aguda, nos anos de 1992 e 1997, que realizaram cultura para V. cholerae pela técnica de TCBSagar durante a vigência de uma epidemia de cólera que tem atingido o Estado de Alagoas desde 1992.

Results

Conclusion