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Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

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  • Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Ponce School of Medicine/Saint Luke's Episcopal Hospital, Ponce, Puerto Rico; Saint Luke's Acute Febrile Illness Investigation Team, Saint Luke's Episcopal Hospital Ponce, Puerto Rico; Zoonotic and Select Agent Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia; Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2–7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs.

Author Notes

* Address correspondence to Olga D. Lorenzi, Dengue Branch, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920. E-mail: oal9@cdc.gov
† Saint Luke's Acute Febrile Illness Investigation Team members: Luis M. Cintrón, Yiraima Medina, Pedro Cordero, Anairis Martínez, Juan P. Fonseca, Alexi Santos, and Julio Bracero.

Authors' addresses: Olga D. Lorenzi, Christopher J. Gregory, Luis Manuel Santiago, Elizabeth Hunsperger, Jorge Muñoz, and Kay M. Tomashek, Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: oal9@cdc.gov, hgk4@cdc.gov, zwt3@cdc.gov, enh4@cdc.gov, ckq2@cdc.gov, and kct9@cdc.gov. Héctor Acosta and Carlos García-Gubern, Ponce School of Medicine, Emergency Medicine Residency Program, Puerto Rico, E-mails: hacosta73@gmail.com and cgarcia@psm.edu. Ivonne E. Galarza, Ponce School of Medicine, Pediatric Residency Program, Ponce, Puerto Rico, E-mail: ivonnegalarza@hotmail.com. Duy M. Bui, Centers for Disease Control and Prevention, Zoonotic and Select Agent Laboratory, Atlanta, GA, E-mail: dbui85@gmail.com. M. Steven Oberste, Centers for Disease Control and Prevention, Respiratory, and Enteric Viruses Branch, Atlanta, GA, E-mail: mbo2@cdc.gov. Silvia Peñaranda, Centers for Disease Control and Prevention, Polio and Picornavirus Branch, Atlanta, GA, E-mail: sxp9@cdc.gov.

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