Acute Febrile Syndrome in an endemic region of Colombia: What is there beyond Dengue?

Abstract

Objective: Evaluate the presence of alternative diagnoses in patients presenting with Acute Febrile Syndrome and a negative Dengue IgM test. Methods: A retrospective descriptive study of the clinical records of patients who presented to the emergency department of ESE Hospital Universitario San Jorge from Pereira, Colombia with Dengue-like Acute Febrile Syndrome between January 2014 and December 2017. Results: 561 patients attended to the emergency department of a third level care and referral center in Pereira, Colombia with a Dengue-like Acute Febrile Syndrome. One hundred thirty three (23.7%) patients were included in the analysis. The three most common alternative diagnoses were leptospirosis (7.5%), malaria (3.8%) and bacterial bloodstream infection (2.3%). The main AFS presentations were hemorrhagic (34.6%), exanthematic (21.1%) and undifferentiated (21.1%). A statistically significant proportion were from rural origin and coursed with anemia, leukocytosis, hyperbilirrubinemia, icterohemorrhagic and icteric AFS. Acute kidney injury with serum creatinine >2 mg/dl and blood urea nitrogen >25 mg/dl were associated with the finding of alternative diagnosis. Conclusions: The low rate of definitive diagnosis, the low request of tests to exclude Malaria, and the significant proportion of Dengue IgM tests requested within the first 4 days of fever, suggests the need to evaluate clinical practice. Training the Emergency Department personnel in the recognition of Acute Febrile Syndrome, as well as the development of prospective investigations, could lead to improvement of the quality of attention, the outcomes, and higher rates of diagnosis.

Keywords

• colombia
• dengue
• diagnosis differential
• fever
• latin america
• zoonoses