Volume 89, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The tourniquet test (TT) is a physical examination maneuver often performed on patients suspected of having dengue. It has been incorporated into dengue diagnostic guidelines and is used in clinical studies. However, little is known about TT performance characteristics in different patient types or epidemiologic conditions. In the dengue-endemic city of Iquitos, Peru, we performed TTs and dengue laboratory assays on 13,548 persons with febrile disease, recruited through either active (n = 1,095) or passive (n = 12,453) surveillance. The sensitivity was 52% and 56%, the specificity was 58% and 68%, the positive predictive value was 45% and 55%, and the negative predictive value was 64% and 69% for persons enrolled in active and passive surveillance, respectively. We demonstrated that the TT was more sensitive identifying dengue disease in women and those of younger age and that sensitivity increased the later a person came to a medical clinic for care.


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  1. Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, Moyes CL, Farlow AW, Scott TW, Hay SI, , 2012. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6: e1760.[Crossref] [Google Scholar]
  2. Potts JA, Rothman AL, , 2008. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health 13: 13281340.[Crossref] [Google Scholar]
  3. Gregory CJ, Lorenzi OD, Colon L, Garcia AS, Santiago LM, Rivera RC, Bermudez LJ, Baez FO, Aponte DV, Tomashek KM, Gutierrez J, Alvarado L, , 2011. Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room. PLoS Negl Trop Dis 5: e1400.[Crossref] [Google Scholar]
  4. Bruce MG, Sanders EJ, Leake JA, Zaidel O, Bragg SL, Aye T, Shutt KA, Deseda CC, Rigau-Perez JG, Tappero JW, Perkins BA, Spiegel RA, Ashford DA, , 2005. Leptospirosis among patients presenting with dengue-like illness in Puerto Rico. Acta Trop 96: 3646.[Crossref] [Google Scholar]
  5. WHO, TDR, 2009. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control: New edition. Available at: http://www.who.int/rpc/guidelines/9789241547871/en/. [Google Scholar]
  6. Blacksell SD, Jarman RG, Bailey MS, Tanganuchitcharnchai A, Jenjaroen K, Gibbons RV, Paris DH, Premaratna R, de Silva HJ, Lalloo DG, Day NP, , 2011. Evaluation of six commercial point-of-care tests for diagnosis of acute dengue infections: the need for combining NS1 antigen and IgM/IgG antibody detection to achieve acceptable levels of accuracy. Clin Vaccine Immunol 18: 20952101.[Crossref] [Google Scholar]
  7. Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV, , 1992. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol 30: 545551. [Google Scholar]
  8. Bethell DB, Gamble J, Pham PL, Nguyen MD, Tran TH, Ha TH, Tran TN, Dong TH, Gartside IB, White NJ, Day NP, , 2001. Noninvasive measurement of microvascular leakage in patients with dengue hemorrhagic fever. Clin Infect Dis 32: 243253.[Crossref] [Google Scholar]
  9. WHO, 1997. Dengue: Clinical diagnosis. Chapter 2. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Second edition. Geneva: World Health Organization. [Google Scholar]
  10. Forshey BM, Morrison AC, Cruz C, Rocha C, Vilcarromero S, Guevara C, Camacho DE, Alava A, Madrid C, Beingolea L, Suarez V, Comach G, Kochel TJ, , 2009. Dengue virus serotype 4, northeastern Peru, 2008. Emerg Infect Dis 15: 18151818.[Crossref] [Google Scholar]
  11. Morrison AC, Minnick SL, Rocha C, Forshey BM, Stoddard ST, Getis A, Focks DA, Russell KL, Olson JG, Blair PJ, Watts DM, Sihuincha M, Scott TW, Kochel TJ, , 2010. Epidemiology of dengue virus in Iquitos, Peru 1999 to 2005: interepidemic and epidemic patterns of transmission. PLoS Negl Trop Dis 4: e670.[Crossref] [Google Scholar]
  12. Forshey BM, Guevara C, Laguna-Torres VA, Cespedes M, Vargas J, Gianella A, Vallejo E, Madrid C, Aguayo N, Gotuzzo E, Suarez V, Morales AM, Beingolea L, Reyes N, Perez J, Negrete M, Rocha C, Morrison AC, Russell KL, Blair PJ, Olson JG, Kochel TJ, , 2010. Arboviral etiologies of acute febrile illnesses in western South America, 2000–2007. PLoS Negl Trop Dis 4: e787.[Crossref] [Google Scholar]
  13. Stoddard ST, Forshey BM, Morrison AC, Paz-Soldan VA, Vazquez-Prokopec GM, Astete H, Reiner RC, Jr Vilcarromero S, Elder JP, Halsey ES, Kochel TJ, Kitron U, Scott TW, , 2013. House-to-house human movement drives dengue virus transmission. Proc Natl Acad Sci USA 110: 994999.[Crossref] [Google Scholar]
  14. 2011. SAS OnlineDoc 9.3. Cary, NC: SAS Institute Inc. [Google Scholar]
  15. R Development Core Team, 2012. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. Available at: http://www.R-project.org/. [Google Scholar]
  16. Gamble J, Bethell D, Day NP, Loc PP, Phu NH, Gartside IB, Farrar JF, White NJ, , 2000. Age-related changes in microvascular permeability: a significant factor in the susceptibility of children to shock? Clin Sci (Lond) 98: 211216.[Crossref] [Google Scholar]
  17. Kabra SK, Jain Y, Pandey RM, Madhulika Singhal T, Tripathi P, Broor S, Seth P, Seth V, , 1999. Dengue haemorrhagic fever in children in the 1996 Delhi epidemic. Trans R Soc Trop Med Hyg 93: 294298.[Crossref] [Google Scholar]
  18. Durand Velazco S, Fiestas Solorzano V, Sihuincha Maldonado M, Chavez Lencinas C, Vasquez Vela V, Torrejon Flores C, Rodriguez Ferruchi H, Cabezas Sanchez C, , 2011. Impact of the dengue epidemic due to a new lineage of DENV-2 American/ Asian genotype in the health services demand in hospital “Cesar Garayar Garcia”, Iquitos. Rev Peru Med Exp Salud Publica 28: 157159.[Crossref] [Google Scholar]
  19. Srikiatkhachorn A, Gibbons RV, Green S, Libraty DH, Thomas SJ, Endy TP, Vaughn DW, Nisalak A, Ennis FA, Rothman AL, Nimmannitaya S, Kalayanarooj S, , 2010. Dengue hemorrhagic fever: the sensitivity and specificity of the world health organization definition for identification of severe cases of dengue in Thailand, 1994–2005. Clin Infect Dis 50: 11351143.[Crossref] [Google Scholar]
  20. Mayxay M, Phetsouvanh R, Moore CE, Chansamouth V, Vongsouvath M, Sisouphone S, Vongphachanh P, Thaojaikong T, Thongpaseuth S, Phongmany S, Keolouangkhot V, Strobel M, Newton PN, , 2011. Predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection in adults. Trop Med Int Health 16: 127133.[Crossref] [Google Scholar]
  21. Hunsperger EA, Yoksan S, Buchy P, Nguyen VC, Sekaran SD, Enria DA, Pelegrino JL, Vazquez S, Artsob H, Drebot M, Gubler DJ, Halstead SB, Guzman MG, Margolis HS, Nathanson CM, Rizzo Lic NR, Bessoff KE, Kliks S, Peeling RW, , 2009. Evaluation of commercially available anti-dengue virus immunoglobulin M tests. Emerg Infect Dis 15: 436440.[Crossref] [Google Scholar]
  22. Ministerio de Salud, Peru. Principales Indicadores del Gasto en Salud. Available at: http://www.minsa.gob.pe/transparencia/gi_docvar.asp#. [Google Scholar]
  23. Potts JA, Thomas SJ, Srikiatkhachorn A, Supradish PO, Li W, Nisalak A, Nimmannitya S, Endy TP, Libraty DH, Gibbons RV, Green S, Rothman AL, Kalayanarooj S, , 2010. Classification of dengue illness based on readily available laboratory data. Am J Trop Med Hyg 83: 781788.[Crossref] [Google Scholar]
  24. Sawasdivorn S, Vibulvattanakit S, Sasavatpakdee M, Iamsirithavorn S, , 2001. Efficacy of clinical diagnosis of dengue fever in paediatric age groups as determined by WHO case definition 1997 in Thailand. Dengue Bull 25: 5664. [Google Scholar]
  25. Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, Viramitrachai W, Ratanachu-eke S, Kiatpolpoj S, Innis BL, Rothman AL, Nisalak A, Ennis FA, , 1997. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis 176: 313321.[Crossref] [Google Scholar]
  26. Norlijah O, Khamisah AN, Kamarul A, Paeds M, Mangalam S, , 2006. Repeated tourniquet testing as a diagnostic tool in dengue infection. Med J Malaysia 61: 2227. [Google Scholar]
  27. Kalayanarooj S, Nimmannitya S, Suntayakorn S, Vaughn DW, Nisalak A, Green S, Chansiriwongs V, Rothman A, Ennis FA, , 1999. Can doctors make an accurate diagnosis of dengue infections at an early stage? Dengue Bull 23: 19. [Google Scholar]

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  • Received : 25 Feb 2013
  • Accepted : 17 Apr 2013
  • Published online : 10 Jul 2013

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