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Simple clinical and laboratory predictors to improve empirical treatment strategies in areas of high scrub typhus and dengue endemicity, central Vietnam
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID 4651880
Author(s) Tran, H. T. D.; Schindler, C.; Pham, T. T. T.; Vien, M. Q.; Do, H. M.; Ngo, Q. T.; Nguyen, T. B.; Hoang, H. T. H.; Vu, L. T. H.; Schelling, E.; Paris, D. H.
Author(s) at UniBasel Tran, Thi Duc Hanh
Schindler, Christian
Paris, Daniel Henry
Year 2022
Title Simple clinical and laboratory predictors to improve empirical treatment strategies in areas of high scrub typhus and dengue endemicity, central Vietnam
Journal PLoS Negl Trop Dis
Volume 16
Number 5
Pages / Article-Number e0010281
Keywords Adult; *Dengue/complications/diagnosis/epidemiology; Fever/epidemiology; Humans; *Lymphadenopathy; *Orientia tsutsugamushi; Retrospective Studies; *Scrub Typhus/diagnosis/epidemiology; Vietnam/epidemiology
Mesh terms Adult; Dengue, epidemiology; Fever, epidemiology; Humans; Lymphadenopathy; Orientia tsutsugamushi; Retrospective Studies; Scrub Typhus, epidemiology; Vietnam, epidemiology
Abstract BACKGROUND: Dengue fever is highly endemic in Vietnam, but scrub typhus-although recognized as an endemic disease-remains underappreciated. These diseases together are likely to account for more than half of the acute undifferentiated fever burden in Vietnam. Scrub typhus (ST) is a bacterial disease requiring antimicrobial treatment, while dengue fever (DF) is of viral etiology and does not. The access to adequate diagnostics and the current understanding of empirical treatment strategies for both illnesses remain limited. In this study we aimed to contribute to the clinical decision process in the management of these two important etiologies of febrile illness in Vietnam. METHODS: Using retrospective data from 221 PCR-confirmed scrub typhus cases and 387 NS1 protein positive dengue fever patients admitted to five hospitals in Khanh Hoa province (central Vietnam), we defined predictive characteristics for both diseases that support simple clinical decision making with potential to inform decision algorithms in future. We developed models to discriminate scrub typhus from dengue fever using multivariable logistic regression (M-LR) and classification and regression trees (CART). Regression trees were developed for the entire data set initially and pruned, based on cross-validation. Regression models were developed in a training data set involving 60% of the total sample and validated in the complementary subsample. Probability cut points for the distinction between scrub typhus and dengue fever were chosen to maximise the sum of sensitivity and specificity. RESULTS: Using M-LR, following seven predictors were identified, that reliably differentiate ST from DF; eschar, regional lymphadenopathy, an occupation in nature, increased days of fever on admission, increased neutrophil count, decreased ratio of neutrophils/lymphocytes, and age over 40. Sensitivity and specificity of predictions based on these seven factors reached 93.7% and 99.5%, respectively. When excluding the "eschar" variable, the values dropped to 76.3% and 92.3%, respectively. The CART model generated one further variable; increased days of fever on admission, when eschar was included, the sensitivity and specificity was 95% and 96.9%, respectively. The model without eschar involved the following six variables; regional lymphadenopathy, increased days of fever on admission, increased neutrophil count, increased lymphocyte count, platelet count >/= 47 G/L and age over 28 years as predictors of ST and provided a sensitivity of 77.4% and a specificity of 90.7%. CONCLUSIONS: The generated algorithms contribute to differentiating scrub typhus from dengue fever using basic clinical and laboratory parameters, supporting clinical decision making in areas where dengue and scrub typhus are co-endemic in Vietnam.
ISSN/ISBN 1935-2735 (Electronic)1935-2727 (Linking)
Full Text on edoc Available
Digital Object Identifier DOI 10.1371/journal.pntd.0010281
PubMed ID
ISI-Number WOS:000867649400005
Document type (ISI) Journal Article

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