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Contribution of Viral Respiratory Infections to Dengue-Like Illness Presentation at a Community Clinic in Southern Malaysia

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  • 1 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia;
  • | 2 Faculty of Medicine, University of Malaya, Malaysia;
  • | 3 United States Naval Medical Research Unit-2, Singapore;
  • | 4 Mahmoodiah Health Clinic, Ministry of Health, Malaysia
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ABSTRACT.

This study explored the contribution of viral respiratory infections (VRIs) in dengue-like illness (DLI) patients and their distinguishing clinicolaboratory parameters. Two hundred DLI patients were prospectively recruited (July 1– October 1, 2019) from a community clinic in Southern Malaysia. Patients ≥ 18 years with acute fever and fulfilling the WHO criteria of probable dengue were recruited. They underwent blood testing: blood counts, rapid dengue tests (nonstructural antigen-1/IgM) and polymerase chain reaction (PCR) for dengue, Zika, chikungunya, and Leptospira. Nasopharyngeal swabs (NPSs) were collected for FilmArray®RP2plus testing. From the 200 NPSs, 58 respiratory viruses (RVs) were detected in 54 patients. Of the 96 dengue-confirmed cases, 86 had dengue mono-infection, and 10 were coinfected with RVs. Of the 104 nondengue, 44 were RV positive and 4 Leptospira positive. Zika and chikungunya virus were not detected. Overall, the etiological diagnosis was confirmed for 72% of patients. Clinicolaboratory parameters were compared between dengue mono-infection and VRI mono-infection. Patients with coinfections were excluded. Multiple logistic regression showed that recent household/neighborhood history of dengue (adjusted odds ratio [aOR]: 5.9, 95% CI = 1.7–20.7), leukopenia (aOR: 12.5, 95% CI = 2.6–61.4) and thrombocytopenia (aOR: 5.5, 95% CI = 1.3–23.0) predicted dengue. Inversely, rhinorrhoea (aOR: 0.1, 95% CI = 0.01–0.3) and cough (aOR: 0.3, 95% CI = 0.1–0.9) favored VRI. Thus, VRIs comprise many infections diagnosed initially as DLIs. Early clinicolaboratory parameters can guide physicians screen patients for further testing.

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Author Notes

Address correspondence to Amreeta Dhanoa, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia. E-mail: amreeta.dhanoa@monash.edu

Financial support: This paper is based on work supported by the United States Naval Medical Research Unit-2 under contract number N6264518D5058—Southeast Asia Biosurveillance and Epidemiology Research (SABER) program, Task Order No. N6264518F0740, Subcontract No. SC-N6264518D5058—Monash-001. This work was funded by the Armed Forces Health Surveillance Division (AFHSD)—Global Emerging Infections Surveillance Branch (GEIS) to the United States Naval Medical Research Unit-2 and approved for human use under IRB Protocol No. NMRR-19-514-47307 and HRPO Project Number: HRPO.NMRCA.2018.003.

Authors’ addresses: Amreeta Dhanoa, Chin Fang Ngim, Lian Yih Pong, and Sharifah Syed Hassan, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, E-mails: amreeta.dhanoa@monash.edu, chin.fang.ngim@monash.edu, ponglianyih@gmail.com, and sharifah.syedhassan@monash.edu. Nor’azim Mohd Yunos, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, and Faculty of Medicine, University of Malaya, Malaysia, E-mail: norazim@ummc.edu.my. Syed M. Tupur Husain and Robert D. Hontz, United States Naval Medical Research Unit-2, Singapore, E-mails: syed.m.husain.mil@mail.mil and robert.d.hontz.mil@mail.mil. Wan Fadhilah Wan Ismail, Mahmoodiah Health Clinic, Ministry of Health, Johor Bahru, Malaysia, E-mail: drwanfadhilah@gmail.com.

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