Acute Febrile Syndrome in an endemic region of Colombia: What is there beyond Dengue?/Síndrome Febril Agudo en una región endémica de Colombia: ¿Qué hay más allá del Dengue?

Objective: Evaluate the presence of alternative diagnoses in patients presenting with Acute Febrile Syndrome (AFS) and a negative Dengue IgMtest. 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 attending 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 an alternative diagnosis. Conclusions: The low rate of definitive diagnosis, the low reguest of tests to exclude Malaria, and the significant proportion of Dengue IgM tests reguested 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 in the guality of attention, the outcomes, and higher rates of diagnosis. Objetivo: evaluar la presencia de diagnósticos alternativos en pacientes con Síndrome Febril Agudo y prueba IgM negativa para Dengue. Métodos: estudio descriptivo retrospectivo de las historias clínicas de los pacientes gue se presentaron al servicio de urgencias de la ESE Hospital Universitario San Jorge de Pereira con Síndrome Febril Agudo similar al Dengue entre enero de 2014 y diciembre de 2017. Resultados: 561 pacientes acudieron al servicio de urgencias con un Síndrome Febril Agudo similar a Dengue. 133 (23,7 %) pacientes fueron analizados. Las tres causas más comunes fueron Leptospirosis (7,5 %), Malaria (3,8 %) y Bacteremia (2,3 %). Las tres presentaciones clínicas más frecuentes de Síndrome Febril Agudo fueron: hemorrágico (34,6 %), exantemático (21,1 %) e indiferenciado (21,1 %). Una proporción significat