The effect of age on dengue presentation and the diagnostic accuracy of the 2015 PAHO case criteria in a Puerto Rican cohort

Abstract Background We evaluated dengue presentation by age, the performance of 2015 PAHO case criteria in identifying cases, and variables to improve specificity. Methods Patients with fever ≤7 days (n = 10,408) were recruited from two emergency departments May 2012–December 2015. Serum samples tested for dengue, chikungunya, nasopharyngeal swabs respiratory viruses. Smoothing splines assessed differences frequencies signs/symptoms age. Least absolute shrinkage selection operator regressions (LASSO) identified that best predicted dengue. Results Among 985 children aged < 5 years least likely have leukopenia, but most rash petechiae. Adults had highest odds aches/pains headaches/retro-orbital pain. The sensitivity specificity 93% 25%. Specificity could be improved by: 1) requiring at following criteria: vomiting/nausea, petechiae, rash, leukopenia (specificity 68%, 71%), or using plus either: AST > 50 IU/L platelet count 100,000 cells/mL 81%, 56%) 2) itchy skin, absence rhinorrhea cough 51%, 82%). Conclusions excellent poor This can adding associated diagnosis.