USING CLINICAL PROFILE AND INITIAL LABORATORY RESULTS TO DIFFERENTIATE LEPTOSPIROSIS, SCRUB TYPHUS AND DENGUE VIRAL INFECTIONS AMONG CHILDREN WITH AN ACUTE FEBRILE ILLNESS

摘要

The clinical manifestations of dengue viral infection (DVI), leptospirosis and scrub typhus are similar, especially during the early stage of illness. We aimed to compare initial clinical profiles and laboratory results in order to determine if these infections can be reliably differentiated using only this information. We conducted a retrospective observational study of patients aged 18 years serologically diagnosed with DVI, leptospirosis or scrub typhus who were treated at Songklanagarind Hospital between 1992 and 2012. The initial clinical presentations and laboratory results of 142 cases were analyzed to identify factors significantly associated with leptospirosis, scrub typhus, and DVI, with 24, 23 and 95 cases, respectively. The median (IQR) age was 9.5 (6.4-12.7) years. Patients with a history of being exposed to a flood/contaminated water, who had a fever for 0 days prior to presentation to the hospital or who had = 70% neutrophils on a peripheral blood smear were significantly more likely to have leptospirosis with relative probability ratios (RPRs) of 72.8, 10.1 and 28.4, respectively (p 0.01). Patients with a fever lasting = 4 days before the first visit and a body temperature 40 degrees C were more likely to have scrub typhus or leptospirosis with RPRs of 26.7 and 4.5, respectively (p 0.01). Patients with 50% lymphocytes or = 50% lymphocytes with a WBC count 5,000 cells/mm(3) were significantly less likely to have leptospirosis or scrub typhus with RPRs of 0 and 0.5, respectively (p 0.01).