The Usefulness of Serum C-Reactive Protein and Total Bilirubin Levels for Distinguishing Between Dengue Fever and Malaria in Returned Travelers

Satoshi Kutsuna National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Kayoko Hayakawa National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Yasuyuki Kato National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Yoshihiro Fujiya National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Momoko Mawatari National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Nozomi Takeshita National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Shuzo Kanagawa National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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Norio Ohmagari National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan

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The clinical manifestations of dengue fever (DF) and malaria are similar. Specific diagnostic tests are not always available. A retrospective study to compare the laboratory results of malaria and DF was conducted at the National Center for Global Health and Medicine in Japan from January of 2005 to March of 2013. Febrile returned travelers from overseas diagnosed with malaria or DF were included; 86 malaria and 85 DF cases were identified. C-reactive protein (CRP) and total bilirubin (T-bil) had high area under the receiver operating characteristic curves (> 0.9). A cutoff value of CRP > 2.4 mg/dL to predict malaria as opposed to DF had a sensitivity of 91.9% (95% confidence interval [95% CI] = 83.9–96.7%) and specificity of 90.6% (95% CI = 82.3–95.8%). A cutoff value of T-bil > 0.9 mg/dL to predict malaria as opposed to DF had a sensitivity of 73.8% (95% CI = 62.7–83%) and a specificity of 95.1% (95% CI = 88–98.6%). CRP and T-bil are useful to distinguish between DF and malaria in returned travelers.

Author Notes

* Address correspondence to Satoshi Kutsuna, 1-21-1-Toyama, Shinjuku-ku, 1-21-1-Toyama, Shinjuku-ku, Tokyo, Japan 162-8655. E-mail: sonare.since1192@gmail.com

Financial support: This work was partly supported by funding from the Research on Emerging and Re-Emerging Infectious Diseases by the Ministry of Health, Labour, and Welfare, Japan (H23-shinkou-ippan-006).

Authors' addresses: Satoshi Kutsuna, Kayoko Hayakawa, Yasuyuki Kato, Yoshihiro Fujiya, Momoko Mawatari, Nozomi Takeshita, Shuzo Kanagawa, and Norio Ohmagari, National Center for Global Health and Medicine, Disease Control and Prevention Center, Toyko, Japan, E-mails: sonare.since1192@gmail.com, kayokohayakawa@gmail.com, katodcc@gmail.com, ilvtkfm@yahoo.co.jp, mawatamo@gmail.com, nozomitake@gmail.com, skanagaw@hosp.ncgm.go.jp, and lukenorioom@gmail.com.

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