Mitra Shubhanker, Gautam Ira, Jambugulam Mohan, Abhilash Kundavaram Paul Prabhakar, Jayaseeelan Vishalakshi
Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
J Glob Infect Dis. 2017 Jan-Mar;9(1):12-17. doi: 10.4103/0974-777X.199996.
Dengue and scrub typhus share similar clinical and epidemiological features, and are difficult to differentiate at initial presentation. Many places are endemic to both these infections where they comprise the majority of acute undifferentiated febrile illnesses.
We aimed to develop a score that can differentiate scrub typhus from dengue. In this cross-sectional study, 188 cases of scrub typhus and 201 cases of dengue infection who presented to the emergency department or medicine outpatient clinic from September 2012 to April 2013 were included. Univariate followed by multivariate logistic regression analysis was performed to identify clinical features and laboratory results that were significantly different between the two groups. Each variable was assigned scores based on the strength of association and receiver operating characteristics area under the curve (ROC-AUC) was generated and compared. Six scoring models were explored to ascertain the model with the best fit.
Model 2 was developed using the following six variables: oxygen saturation (>90%, ≤90%), total white blood cell count (<4000, 4001-7000 and >7000 cells/cumm), hemoglobin (≤14 and >14 g/dL), total bilirubin (<2 and ≥2 mg/dL), serum glutamic oxaloacetic transaminase (>200 and ≥200 IU/dL), and altered sensorium (present or absent). Each variable was assigned scores based on its strength of association. The AUC-ROC curve (95% confidence interval) for model 2 was 0.84 (0.79-0.89). At the cut off score of 13, the sensitivity and specificity were 85% and 77% respectively, with a higher score favoring dengue.
In areas of high burden of ST and dengue, model 2 (the "clinical score to differentiate scrub typhus and dengue fever") is a simple and rapid clinical scoring system that may be used to differentiate scrub typhus and dengue at initial presentation.
登革热和恙虫病具有相似的临床和流行病学特征，在初诊时难以鉴别。在许多地方，这两种感染均为地方病，它们构成了大多数急性未分化发热性疾病。
我们旨在开发一种能够区分恙虫病和登革热的评分系统。在这项横断面研究中，纳入了2012年9月至2013年4月期间到急诊科或内科门诊就诊的188例恙虫病患者和201例登革热感染患者。先进行单因素分析，然后进行多因素逻辑回归分析，以确定两组之间存在显著差异的临床特征和实验室检查结果。根据关联强度为每个变量赋值，并生成并比较曲线下面积（ROC-AUC）。探索了六种评分模型，以确定拟合度最佳的模型。
模型2是使用以下六个变量开发的：血氧饱和度（>90%，≤90%）、白细胞总数（<4000、4001 - 7000和>7000个/立方毫米）、血红蛋白（≤14和>14克/分升）、总胆红素（<2和≥2毫克/分升）、血清谷草转氨酶（>200和≥200国际单位/升）以及意识改变（存在或不存在）。根据每个变量的关联强度为其赋值。模型2的AUC-ROC曲线（95%置信区间）为0.84（0.79 - 0.89）。在截断分数为13时，敏感性和特异性分别为85%和77%，分数越高越支持登革热诊断。
在恙虫病和登革热负担较重的地区，模型2（“区分恙虫病和登革热的临床评分”）是一种简单快速的临床评分系统，可用于在初诊时区分恙虫病和登革热。
