Factores asociados con la presencia de dengue grave en pacientes colombianos con diagnóstico confirmado de dengue 2013-2015

Introducción: El dengue es el arbovirus más importante del mundo. Colombia es hiperendémico por esta enfermedad y su complicación severa está presente en la población colombiana. Objetivo: Determinar los factores sociodemográficos, clínicos y de laboratorio que se asocian con la presencia de dengue grave en pacientes Colombianos con diagnostico confirmado de dengue notificados al Sistema Nacional de Vigilancia en Salud Pública durante los años 2013 – 2015. Métodos: Es un estudio observacional analítico retrospectivo de corte transversal. Se evaluó la asociación entre la variable dependiente y las independientes mediante U Mann-Whitney y Chi cuadrado o test exacto de Fisher. Las variables que mostraron un valor de (p < 0,25) se incluyeron en el análisis multivariado. Resultados: En los 1172 casos con criterios de inclusión (1044 de dengue y 128 dengue grave), el 50% de los pacientes diagnosticados con dengue tenían menos de 19 años. Los resultados del análisis multivariado mostraron: leucocitosis p= 0,026, trombocitopenia p < 0,001, presencia de melenas (OR= 48,97; IC 95%: 7,90-303,30), hemoptisis (OR= 46,71; IC 95%: 3,59-606,54),hipotensión (OR= 12,06; IC 95%: 4,68-31,04), hepatomegalia (OR= 10,34; IC 95%: 3,66-29,21), gingivorrea (OR= 6,45; IC 95%: 1,76-23,56), petequias (OR= 2,87; IC 95%: 0,98-8,39), dolor abdominal (OR= 2,42; IC 95%: 1,22-4,79), cefalea (OR= 0,38; IC 95%: 0,19-0,76) y serotipo DENV2 (OR 2,62; IC 95%: 1,25-5,50). Conclusiones: La mayoría de variables asociadas con la presencia de dengue grave en este estudio fueron clínicas donde las manifestaciones de sangrado tienen un peso importante dentro de los resultados; sin embargo, el encontrar asociado el serotipo DENV2 lo convierte en un hallazgo relevante en la gravedad de la enfermedad también reportado en varias publicaciones a nivel mundial.Introduction: Dengue is the most important arboviruses around the world. Colombia is hyperendemic for this disease and their severe complication is present in the population Colombian. Objective: To determine the sociodemographic, clinical and laboratory factors associated with the presence of severe dengue in Colombian patients with a confirmed diagnosis of dengue reported to the National Public Health Surveillance System during the years 2013 - 2015. Methodology: Cross-sectional retrospective analytical observational study. The association between the dependent variable and the independent ones was evaluated by U Mann-Whitney and Chi square or Fisher's exact test. The variables that showed a value of (p <0.25) were included in the multivariate analysis. Results: Of the total cases (1172) with inclusion criteria (1044 dengue and 128 severe dengue), 50% of the patients diagnosed with dengue were under 19 years of age. The multivariate analysis showed: leukocytosis p=0.026, thrombocytopenia p <0.001, presence of manes (OR = 48.97, 95% CI: 7.90-303.30), hemoptysis (OR = 46.71, CI 95 %: 3.59-606.54), hypotension (OR = 12.06, 95% CI: 4.68-31.04), hepatomegaly (OR = 10.34, 95% CI: 3.66-29, 21), gingivorrea (OR = 6.45, 95% CI: 1.76-23.56), petechiae (OR = 2.87, 95% CI: 0.98-8.39), abdominal pain (OR = 2.42, 95% CI: 1.22-4.79), headache (OR = 0.38, 95% CI: 0.19-0.76) and serotype DENV2 (OR 2.62, 95% CI: 1.25-5.50). Conclusions: Most of the variables associated in this study with the presence of severe dengue corresponding to clinical manifestations, where the bleeding have a significant weight within the results; however, the finding associated with serotype DENV2 makes it a relevant finding in the prognostic of severity of the disease, this association was also reported by other authors in different studies worldwide.2019-08-01 06:01:01: Script de automatizacion de embargos. info:eu-repo/date/embargoEnd/2019-06-0

Factores asociados con la presencia de dengue grave en pacientes colombianos con diagnóstico confirmado de dengue 2013-2015

Introducción: El dengue es el arbovirus más importante del mundo. Colombia es hiperendémico por esta enfermedad y su complicación severa está presente en la población colombiana. Objetivo: Determinar los factores sociodemográficos, clínicos y de laboratorio que se asocian con la presencia de dengue grave en pacientes Colombianos con diagnostico confirmado de dengue notificados al Sistema Nacional de Vigilancia en Salud Pública durante los años 2013 – 2015. Métodos: Es un estudio observacional analítico retrospectivo de corte transversal. Se evaluó la asociación entre la variable dependiente y las independientes mediante U Mann-Whitney y Chi cuadrado o test exacto de Fisher. Las variables que mostraron un valor de (p < 0,25) se incluyeron en el análisis multivariado. Resultados: En los 1172 casos con criterios de inclusión (1044 de dengue y 128 dengue grave), el 50% de los pacientes diagnosticados con dengue tenían menos de 19 años. Los resultados del análisis multivariado mostraron: leucocitosis p= 0,026, trombocitopenia p < 0,001, presencia de melenas (OR= 48,97; IC 95%: 7,90-303,30), hemoptisis (OR= 46,71; IC 95%: 3,59-606,54),hipotensión (OR= 12,06; IC 95%: 4,68-31,04), hepatomegalia (OR= 10,34; IC 95%: 3,66-29,21), gingivorrea (OR= 6,45; IC 95%: 1,76-23,56), petequias (OR= 2,87; IC 95%: 0,98-8,39), dolor abdominal (OR= 2,42; IC 95%: 1,22-4,79), cefalea (OR= 0,38; IC 95%: 0,19-0,76) y serotipo DENV2 (OR 2,62; IC 95%: 1,25-5,50). Conclusiones: La mayoría de variables asociadas con la presencia de dengue grave en este estudio fueron clínicas donde las manifestaciones de sangrado tienen un peso importante dentro de los resultados; sin embargo, el encontrar asociado el serotipo DENV2 lo convierte en un hallazgo relevante en la gravedad de la enfermedad también reportado en varias publicaciones a nivel mundial.Introduction: Dengue is the most important arboviruses around the world. Colombia is hyperendemic for this disease and their severe complication is present in the population Colombian. Objective: To determine the sociodemographic, clinical and laboratory factors associated with the presence of severe dengue in Colombian patients with a confirmed diagnosis of dengue reported to the National Public Health Surveillance System during the years 2013 - 2015. Methodology: Cross-sectional retrospective analytical observational study. The association between the dependent variable and the independent ones was evaluated by U Mann-Whitney and Chi square or Fisher's exact test. The variables that showed a value of (p <0.25) were included in the multivariate analysis. Results: Of the total cases (1172) with inclusion criteria (1044 dengue and 128 severe dengue), 50% of the patients diagnosed with dengue were under 19 years of age. The multivariate analysis showed: leukocytosis p=0.026, thrombocytopenia p <0.001, presence of manes (OR = 48.97, 95% CI: 7.90-303.30), hemoptysis (OR = 46.71, CI 95 %: 3.59-606.54), hypotension (OR = 12.06, 95% CI: 4.68-31.04), hepatomegaly (OR = 10.34, 95% CI: 3.66-29, 21), gingivorrea (OR = 6.45, 95% CI: 1.76-23.56), petechiae (OR = 2.87, 95% CI: 0.98-8.39), abdominal pain (OR = 2.42, 95% CI: 1.22-4.79), headache (OR = 0.38, 95% CI: 0.19-0.76) and serotype DENV2 (OR 2.62, 95% CI: 1.25-5.50). Conclusions: Most of the variables associated in this study with the presence of severe dengue corresponding to clinical manifestations, where the bleeding have a significant weight within the results; however, the finding associated with serotype DENV2 makes it a relevant finding in the prognostic of severity of the disease, this association was also reported by other authors in different studies worldwide

Development and validation of a rapid lateral flow E1/E2-antigen test and ELISA in patients infected with emerging Asian strain of Chikungunya virus in the Americas

Since its 2013 emergence in the Americas, Chikungunya virus (CHIKV) has posed a serious threat to public health. Early and accurate diagnosis of the disease, though currently lacking in clinics, is integral to enable timely care and epidemiological response. We developed a dual detection system: a CHIKV antigen E1/E2-based enzyme-linked immunosorbent assay (ELISA) and a lateral flow test using high-affinity anti-CHIKV antibodies. The ELISA was validated with 100 PCR-tested acute Chikungunya fever samples from Honduras. The assay had an overall sensitivity and specificity of 51% and 96.67%, respectively, with accuracy reaching 95.45% sensitivity and 92.03% specificity at a cycle threshold (Ct) cutoff of 22. As the Ct value decreased from 35 to 22, the ELISA sensitivity increased. We then developed and validated two lateral flow tests using independent antibody pairs. The sensitivity and specificity reached 100% for both lateral flow tests using 39 samples from Colombia and Honduras at Ct cutoffs of 20 and 27, respectively. For both lateral flow tests, sensitivity decreased as the Ct increased after 27. Because CHIKV E1/E2 are exposed in the virion surfaces in serum during the acute infection phase, these sensitive and specific assays demonstrate opportunities for early detection of this emerging human pathogen.U.S. Public Health Service (award AI100190