UMR Processus Infectieux en Milieux Insulaire Tropical (CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion), Sainte Clotilde, La Réunion, France.
INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France.
PLoS One. 2024 Feb 15;19(2):e0295260. doi: 10.1371/journal.pone.0295260. eCollection 2024.
The relevance of the World Health Organization (WHO) criteria for defining probable dengue had not yet been evaluated in the context of dengue endemicity on Reunion Island. The objective of this retrospective diagnostic study was to evaluate the diagnostic performance of the 2009 WHO definition of probable dengue and to propose an improvement thereof. From the medical database, we retrieved the data of subjects admitted to the emergency department of the University Hospital of Reunion Island in 2019 with suspected dengue fever (DF) within a maximum of 5 days post symptom onset, and whose diagnosis was confirmed by a Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The intrinsic characteristics of probable dengue definitions were reported in terms of sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), using RT-PCR as the gold standard. Of the 1,181 subjects who exhibited a positive RT-PCR, 652 (55%) were classified as probable dengue. The WHO definition of probable dengue yielded a sensitivity of 64% (95%CI 60-67%), a specificity of 57% (95%CI 52-61%), a LR+ of 1.49 (95%CI 1.33-1.67), and a LR- of 0.63 (95%CI 0.56-0.72). The sensitivity and LR- for diagnosing and ruling out probable dengue could be improved by the addition of lymphopenia on admission (74% [95%CI: 71-78%] and 0.54 [95%CI: 0.46-0.63] respectively), at the cost of slight reductions of specificity and LR+ (48% [95%CI: 44-53%] and 1.42 [95%CI: 1.29-1.57], respectively). In the absence of, or when rapid diagnostic testing is unreliable, the use of the improved 2009 WHO definition of probable dengue could facilitate the identification of subjects who require further RT-PCR testing, which should encourage the development of patient management, while also optimizing the count and quarantine of cases, and guiding disease control.
世界卫生组织（WHO）用于定义可能登革热的标准在留尼汪岛登革热流行地区的相关性尚未得到评估。本回顾性诊断研究的目的是评估 2009 年 WHO 可能登革热定义的诊断性能，并提出改进方案。从医疗数据库中，我们检索了 2019 年在留尼汪岛大学医院急诊科就诊的疑似登革热（DF）患者的资料，这些患者在症状出现后 5 天内最多接受了逆转录聚合酶链反应（RT-PCR）检测，且其诊断均经 RT-PCR 证实。根据 RT-PCR 作为金标准，报告了可能登革热定义的固有特征，包括灵敏度、特异性、阳性和阴性似然比（LR+和 LR-）。在 1181 例 RT-PCR 阳性的患者中，652 例（55%）被归类为可能登革热。WHO 可能登革热的定义得出的灵敏度为 64%（95%CI 60-67%），特异性为 57%（95%CI 52-61%），LR+为 1.49（95%CI 1.33-1.67），LR-为 0.63（95%CI 0.56-0.72）。通过在入院时添加淋巴细胞减少症（诊断和排除可能登革热的灵敏度分别为 74%[95%CI：71-78%]和 0.54[95%CI：0.46-0.63]），可以提高诊断和排除可能登革热的灵敏度和 LR-，但特异性和 LR+会略有降低（分别为 48%[95%CI：44-53%]和 1.42[95%CI：1.29-1.57]）。在没有快速诊断检测或快速诊断检测不可靠的情况下，使用改进后的 2009 年 WHO 可能登革热定义可以帮助识别需要进一步 RT-PCR 检测的患者，这应该鼓励患者管理的发展，同时优化病例的计数和隔离，并指导疾病控制。
