Spotlight: Contribution of Viral Respiratory Infections to Dengue-Like Illness Presentation at a Community Clinic in Southern Malaysia

Vysnova collaborated with the Monash University Malaysia and successfully conducted a surveillance study that was featured in The American Journal of Tropical Medicine and Hygiene (ASTMH). The study explored the contribution of viral respiratory infections (VRIs) in dengue-like illness (DLI) patients and early clinical and laboratory parameters that can distinguish dengue from VRIs. Two hundred DLI patients were prospectively recruited (July 1– October 1, 2019) from a community clinic in Southern Malaysia. Patients over 18 years old with acute fever and fulfilling the WHO criteria of probable dengue were recruited. They underwent blood testing: blood counts, rapid dengue tests (nonstructural antigen-1/IgM), and polymerase chain reaction (PCR) for dengue, Zika, chikungunya, and Leptospira. Nasopharyngeal swabs (NPSs) were collected for FilmArray®RP2plus testing. From the 200 NPSs, 58 respiratory viruses (RVs) were detected in 54 patients. Of the 96 dengue-confirmed cases, 86 had dengue mono-infection, and 10 were co-infected with RVs. Of the 104 non-dengue, 44 were RV positive and 4 Leptospira positive. Zika and chikungunya virus were not detected. Overall, the etiological diagnosis was confirmed for 72% of patients.

Clinicolaboratory parameters were compared between dengue mono-infection and VRI mono-infection. Patients with co-infections were excluded. Multiple logistic regression showed that recent household/neighborhood history of dengue (adjusted odds ratio [aOR]: 5.9, 95% CI = 1.7–20.7), leukopenia (aOR: 12.5, 95% CI = 2.6–61.4) and thrombocytopenia (aOR: 5.5, 95% CI = 1.3–23.0) predicted dengue. Inversely, rhinorrhoea (aOR: 0.1, 95% CI = 0.01–0.3) and cough (aOR: 0.3, 95% CI = 0.1–0.9) favored VRI. 

The study suggests that VRIs comprise many infections clinically diagnosed initially as DLIs. Early clinicolaboratory parameters can guide physicians to screen patients for further testing, especially in settings where point-of-care testing for RVs is sparse and the burden of dengue and RVs is high.

Source: https://www.ajtmh.org/view/journals/tpmd/106/1/article-p187.xml