Chikungunya fever: How accurate is the clinical-epidemiological diagnosis compared to the gold standard of molecular and serological laboratory diagnosis?
To evaluate the accuracy of the current World Health Organization' (WHO) Chikungunya fever (CHIKF) clinical-epidemiological case definition against the gold standard of laboratory diagnosis. This was a prospective study of patients seeking medical care at an Emergency Department in the metropol...
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| Veröffentlicht in: | Journal of clinical virology 2020-12, Vol.133, p.104679-104679, Article 104679 |
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| creator | de Paula, Hury Hellen Souza Martins, André Frederico das Chagas, Raphael Rangel Moreira, José de Aguiar, Renato Santana da Cruz Lamas, Cristiane Cardozo, Sergian Vianna |
| description | To evaluate the accuracy of the current World Health Organization' (WHO) Chikungunya fever (CHIKF) clinical-epidemiological case definition against the gold standard of laboratory diagnosis.
This was a prospective study of patients seeking medical care at an Emergency Department in the metropolitan area of Rio de Janeiro, Brazil, from January to June 2018. Clinical features were recorded. Screening for CHIKF was performed using the RT-qPCR and ELISA-IgM antibody assay. Clinical features of CHIKF RT-qPCR/IgM positive cases were compared with those with other febrile illnesses.
27,900 ED visits were recorded, of which 172 (0.61 %) patients were screened for arboviral illness. The prevalence of laboratory-confirmed CHIKF (Lab-CHIKF) was 110/172 [64 %]. Chikungunya virus RNA was detected in 92/172 (53.5 %) patients, while in 18/80 (10.5 %), only IgM was positive. Compared to CHIKV-negative subjects, patients with CHIKF presented much earlier after the onset of symptoms (2 [1–4] vs. 3.5 [2.5−5], p = 0.007), and more frequently reported arthritis (61.8 % vs. 33.9 %, p |
| doi_str_mv | 10.1016/j.jcv.2020.104679 |
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This was a prospective study of patients seeking medical care at an Emergency Department in the metropolitan area of Rio de Janeiro, Brazil, from January to June 2018. Clinical features were recorded. Screening for CHIKF was performed using the RT-qPCR and ELISA-IgM antibody assay. Clinical features of CHIKF RT-qPCR/IgM positive cases were compared with those with other febrile illnesses.
27,900 ED visits were recorded, of which 172 (0.61 %) patients were screened for arboviral illness. The prevalence of laboratory-confirmed CHIKF (Lab-CHIKF) was 110/172 [64 %]. Chikungunya virus RNA was detected in 92/172 (53.5 %) patients, while in 18/80 (10.5 %), only IgM was positive. Compared to CHIKV-negative subjects, patients with CHIKF presented much earlier after the onset of symptoms (2 [1–4] vs. 3.5 [2.5−5], p = 0.007), and more frequently reported arthritis (61.8 % vs. 33.9 %, p < 0.0001), arthralgia (96.4 % vs. 79 %, p < 0.0001), and conjunctivitis (35.5 % vs. 16.1 %, p = 0.007). After adjustments for other clinical predictors, arthritis/arthralgia [aOR: 6 (95 % CI 1.8–19.7)] and the presence of conjunctivitis [aOR: 2.85 (95 % CI 1.30−6.24] were positively associated with lab-CHIKF. The sensitivity, specificity, positive predictive value, and negative predictive value of the WHO CHIKF clinical case definition was 96.3 %, 20.9 %, 68.3 % and 76.4 %, respectively, and accuracy was 0.69 [AUC: 0.69 (95 % CI 0.61−0.75)].
The WHO case definition needs to be improved for better accuracy, especially in areas in epidemics in areas with co-circulation of arboviruses.</description><identifier>ISSN: 1386-6532</identifier><identifier>EISSN: 1873-5967</identifier><identifier>DOI: 10.1016/j.jcv.2020.104679</identifier><identifier>PMID: 33197755</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Accuracy ; Case definition ; Chikungunya fever ; Laboratory diagnosis</subject><ispartof>Journal of clinical virology, 2020-12, Vol.133, p.104679-104679, Article 104679</ispartof><rights>2020 Elsevier B.V.</rights><rights>Copyright © 2020 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c305t-640794023eb0e12611695603a981bcd930441053a86b7b13a47872ca0221ff933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jcv.2020.104679$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33197755$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Paula, Hury Hellen Souza</creatorcontrib><creatorcontrib>Martins, André Frederico</creatorcontrib><creatorcontrib>das Chagas, Raphael Rangel</creatorcontrib><creatorcontrib>Moreira, José</creatorcontrib><creatorcontrib>de Aguiar, Renato Santana</creatorcontrib><creatorcontrib>da Cruz Lamas, Cristiane</creatorcontrib><creatorcontrib>Cardozo, Sergian Vianna</creatorcontrib><title>Chikungunya fever: How accurate is the clinical-epidemiological diagnosis compared to the gold standard of molecular and serological laboratory diagnosis?</title><title>Journal of clinical virology</title><addtitle>J Clin Virol</addtitle><description>To evaluate the accuracy of the current World Health Organization' (WHO) Chikungunya fever (CHIKF) clinical-epidemiological case definition against the gold standard of laboratory diagnosis.
This was a prospective study of patients seeking medical care at an Emergency Department in the metropolitan area of Rio de Janeiro, Brazil, from January to June 2018. Clinical features were recorded. Screening for CHIKF was performed using the RT-qPCR and ELISA-IgM antibody assay. Clinical features of CHIKF RT-qPCR/IgM positive cases were compared with those with other febrile illnesses.
27,900 ED visits were recorded, of which 172 (0.61 %) patients were screened for arboviral illness. The prevalence of laboratory-confirmed CHIKF (Lab-CHIKF) was 110/172 [64 %]. Chikungunya virus RNA was detected in 92/172 (53.5 %) patients, while in 18/80 (10.5 %), only IgM was positive. Compared to CHIKV-negative subjects, patients with CHIKF presented much earlier after the onset of symptoms (2 [1–4] vs. 3.5 [2.5−5], p = 0.007), and more frequently reported arthritis (61.8 % vs. 33.9 %, p < 0.0001), arthralgia (96.4 % vs. 79 %, p < 0.0001), and conjunctivitis (35.5 % vs. 16.1 %, p = 0.007). After adjustments for other clinical predictors, arthritis/arthralgia [aOR: 6 (95 % CI 1.8–19.7)] and the presence of conjunctivitis [aOR: 2.85 (95 % CI 1.30−6.24] were positively associated with lab-CHIKF. The sensitivity, specificity, positive predictive value, and negative predictive value of the WHO CHIKF clinical case definition was 96.3 %, 20.9 %, 68.3 % and 76.4 %, respectively, and accuracy was 0.69 [AUC: 0.69 (95 % CI 0.61−0.75)].
The WHO case definition needs to be improved for better accuracy, especially in areas in epidemics in areas with co-circulation of arboviruses.</description><subject>Accuracy</subject><subject>Case definition</subject><subject>Chikungunya fever</subject><subject>Laboratory diagnosis</subject><issn>1386-6532</issn><issn>1873-5967</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc1O3DAURq0KVCjtA3SDvGSTqX8SO6aLCo1oQUJi064tx74ZPDjxYCeD5lV42no6lO66sq_1fefKOgh9pmRBCRVf1ou13S4YYfu5FlK9Q6e0lbxqlJBH5c5bUYmGsxP0Iec1IbThtXyPTjinSsqmOUUvywf_OI-redwZ3MMW0iW-ic_YWDsnMwH2GU8PgG3wo7cmVLDxDgYfQ1ztZ-y8WY0xl5iNw8YkcHiKfyqrGBzOkxmdSQ7HHg8xgJ2DSbi84QzpDRJMF8u2mHb_eN8-ouPehAyfXs8z9Ov79c_lTXV3_-N2eXVXWU6aqRI1kaomjENHgDJBqVCNINyolnbWKU7qmpKGm1Z0sqPc1LKVzBrCGO17xfkZujhwNyk-zZAnPfhsIQQzQpyzZrWgXFFB2hKlh6hNMecEvd4kP5i005TovRK91kWJ3ivRByWlc_6Kn7sB3Fvjr4MS-HoIQPnk1kPS2XoYLTifwE7aRf8f_G_hxJ3f</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>de Paula, Hury Hellen Souza</creator><creator>Martins, André Frederico</creator><creator>das Chagas, Raphael Rangel</creator><creator>Moreira, José</creator><creator>de Aguiar, Renato Santana</creator><creator>da Cruz Lamas, Cristiane</creator><creator>Cardozo, Sergian Vianna</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202012</creationdate><title>Chikungunya fever: How accurate is the clinical-epidemiological diagnosis compared to the gold standard of molecular and serological laboratory diagnosis?</title><author>de Paula, Hury Hellen Souza ; Martins, André Frederico ; das Chagas, Raphael Rangel ; Moreira, José ; de Aguiar, Renato Santana ; da Cruz Lamas, Cristiane ; Cardozo, Sergian Vianna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-640794023eb0e12611695603a981bcd930441053a86b7b13a47872ca0221ff933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Accuracy</topic><topic>Case definition</topic><topic>Chikungunya fever</topic><topic>Laboratory diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Paula, Hury Hellen Souza</creatorcontrib><creatorcontrib>Martins, André Frederico</creatorcontrib><creatorcontrib>das Chagas, Raphael Rangel</creatorcontrib><creatorcontrib>Moreira, José</creatorcontrib><creatorcontrib>de Aguiar, Renato Santana</creatorcontrib><creatorcontrib>da Cruz Lamas, Cristiane</creatorcontrib><creatorcontrib>Cardozo, Sergian Vianna</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical virology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Paula, Hury Hellen Souza</au><au>Martins, André Frederico</au><au>das Chagas, Raphael Rangel</au><au>Moreira, José</au><au>de Aguiar, Renato Santana</au><au>da Cruz Lamas, Cristiane</au><au>Cardozo, Sergian Vianna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chikungunya fever: How accurate is the clinical-epidemiological diagnosis compared to the gold standard of molecular and serological laboratory diagnosis?</atitle><jtitle>Journal of clinical virology</jtitle><addtitle>J Clin Virol</addtitle><date>2020-12</date><risdate>2020</risdate><volume>133</volume><spage>104679</spage><epage>104679</epage><pages>104679-104679</pages><artnum>104679</artnum><issn>1386-6532</issn><eissn>1873-5967</eissn><abstract>To evaluate the accuracy of the current World Health Organization' (WHO) Chikungunya fever (CHIKF) clinical-epidemiological case definition against the gold standard of laboratory diagnosis.
This was a prospective study of patients seeking medical care at an Emergency Department in the metropolitan area of Rio de Janeiro, Brazil, from January to June 2018. Clinical features were recorded. Screening for CHIKF was performed using the RT-qPCR and ELISA-IgM antibody assay. Clinical features of CHIKF RT-qPCR/IgM positive cases were compared with those with other febrile illnesses.
27,900 ED visits were recorded, of which 172 (0.61 %) patients were screened for arboviral illness. The prevalence of laboratory-confirmed CHIKF (Lab-CHIKF) was 110/172 [64 %]. Chikungunya virus RNA was detected in 92/172 (53.5 %) patients, while in 18/80 (10.5 %), only IgM was positive. Compared to CHIKV-negative subjects, patients with CHIKF presented much earlier after the onset of symptoms (2 [1–4] vs. 3.5 [2.5−5], p = 0.007), and more frequently reported arthritis (61.8 % vs. 33.9 %, p < 0.0001), arthralgia (96.4 % vs. 79 %, p < 0.0001), and conjunctivitis (35.5 % vs. 16.1 %, p = 0.007). After adjustments for other clinical predictors, arthritis/arthralgia [aOR: 6 (95 % CI 1.8–19.7)] and the presence of conjunctivitis [aOR: 2.85 (95 % CI 1.30−6.24] were positively associated with lab-CHIKF. The sensitivity, specificity, positive predictive value, and negative predictive value of the WHO CHIKF clinical case definition was 96.3 %, 20.9 %, 68.3 % and 76.4 %, respectively, and accuracy was 0.69 [AUC: 0.69 (95 % CI 0.61−0.75)].
The WHO case definition needs to be improved for better accuracy, especially in areas in epidemics in areas with co-circulation of arboviruses.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>33197755</pmid><doi>10.1016/j.jcv.2020.104679</doi><tpages>1</tpages></addata></record> |
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| title | Chikungunya fever: How accurate is the clinical-epidemiological diagnosis compared to the gold standard of molecular and serological laboratory diagnosis? |
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