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Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia

BACKGROUND: The lack of characteristic clinical findings and accurate diagnostic tools has made the diagnosis of enteric fever difficult. We evaluated the classic signs of relative bradycardia and eosinopenia as diagnostic predictors for enteric fever among travellers who had returned from the tropi...

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Autores principales: Matono, Takashi, Kutsuna, Satoshi, Kato, Yasuyuki, Katanami, Yuichi, Yamamoto, Kei, Takeshita, Nozomi, Hayakawa, Kayoko, Kanagawa, Shuzo, Kaku, Mitsuo, Ohmagari, Norio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482448/
https://www.ncbi.nlm.nih.gov/pubmed/28644847
http://dx.doi.org/10.1371/journal.pone.0179814
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author Matono, Takashi
Kutsuna, Satoshi
Kato, Yasuyuki
Katanami, Yuichi
Yamamoto, Kei
Takeshita, Nozomi
Hayakawa, Kayoko
Kanagawa, Shuzo
Kaku, Mitsuo
Ohmagari, Norio
author_facet Matono, Takashi
Kutsuna, Satoshi
Kato, Yasuyuki
Katanami, Yuichi
Yamamoto, Kei
Takeshita, Nozomi
Hayakawa, Kayoko
Kanagawa, Shuzo
Kaku, Mitsuo
Ohmagari, Norio
author_sort Matono, Takashi
collection PubMed
description BACKGROUND: The lack of characteristic clinical findings and accurate diagnostic tools has made the diagnosis of enteric fever difficult. We evaluated the classic signs of relative bradycardia and eosinopenia as diagnostic predictors for enteric fever among travellers who had returned from the tropics or subtropics. METHODS: This matched case-control study used data from 2006 to 2015 for culture-proven enteric fever patients as cases. Febrile patients (>38.3°C) with non-enteric fever, who had returned from the tropics or subtropics, were matched to the cases in a 1:3 ratio by age (±3 years), sex, and year of diagnosis as controls. Cunha’s criteria were used for relative bradycardia. Absolute eosinopenia was defined as an eosinophilic count of 0/μL. RESULTS: Data from 160 patients (40 cases and 120 controls) were analysed. Cases predominantly returned from South Asia (70% versus 18%, p <0.001). Relative bradycardia (88% versus 51%, p <0.001) and absolute eosinopenia (63% versus 38%, p = 0.008) were more frequent in cases than controls. In multivariate logistic regression analysis, return from South Asia (aOR: 21.6; 95% CI: 7.17–64.9) and relative bradycardia (aOR: 11.7; 95% CI: 3.21–42.5) were independent predictors for a diagnosis of enteric fever. The positive likelihood ratio was 4.00 (95% CI: 2.58–6.20) for return from South Asia, 1.72 (95% CI: 1.39–2.13) for relative bradycardia, and 1.63 (95%CI: 1.17–2.27) for absolute eosinopenia. The negative predictive values of the three variables were notably high (83–92%);. however, positive predictive values were 35–57%. CONCLUSIONS: The classic signs of relative bradycardia and eosinopenia were not specific for enteric fever; however both met the criteria for being diagnostic predictors for enteric fever. Among febrile returned travellers, relative bradycardia and eosinopenia should be re-evaluated for predicting a diagnosis of enteric fever in non-endemic areas prior to obtaining blood cultures.
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spelling pubmed-54824482017-07-06 Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia Matono, Takashi Kutsuna, Satoshi Kato, Yasuyuki Katanami, Yuichi Yamamoto, Kei Takeshita, Nozomi Hayakawa, Kayoko Kanagawa, Shuzo Kaku, Mitsuo Ohmagari, Norio PLoS One Research Article BACKGROUND: The lack of characteristic clinical findings and accurate diagnostic tools has made the diagnosis of enteric fever difficult. We evaluated the classic signs of relative bradycardia and eosinopenia as diagnostic predictors for enteric fever among travellers who had returned from the tropics or subtropics. METHODS: This matched case-control study used data from 2006 to 2015 for culture-proven enteric fever patients as cases. Febrile patients (>38.3°C) with non-enteric fever, who had returned from the tropics or subtropics, were matched to the cases in a 1:3 ratio by age (±3 years), sex, and year of diagnosis as controls. Cunha’s criteria were used for relative bradycardia. Absolute eosinopenia was defined as an eosinophilic count of 0/μL. RESULTS: Data from 160 patients (40 cases and 120 controls) were analysed. Cases predominantly returned from South Asia (70% versus 18%, p <0.001). Relative bradycardia (88% versus 51%, p <0.001) and absolute eosinopenia (63% versus 38%, p = 0.008) were more frequent in cases than controls. In multivariate logistic regression analysis, return from South Asia (aOR: 21.6; 95% CI: 7.17–64.9) and relative bradycardia (aOR: 11.7; 95% CI: 3.21–42.5) were independent predictors for a diagnosis of enteric fever. The positive likelihood ratio was 4.00 (95% CI: 2.58–6.20) for return from South Asia, 1.72 (95% CI: 1.39–2.13) for relative bradycardia, and 1.63 (95%CI: 1.17–2.27) for absolute eosinopenia. The negative predictive values of the three variables were notably high (83–92%);. however, positive predictive values were 35–57%. CONCLUSIONS: The classic signs of relative bradycardia and eosinopenia were not specific for enteric fever; however both met the criteria for being diagnostic predictors for enteric fever. Among febrile returned travellers, relative bradycardia and eosinopenia should be re-evaluated for predicting a diagnosis of enteric fever in non-endemic areas prior to obtaining blood cultures. Public Library of Science 2017-06-23 /pmc/articles/PMC5482448/ /pubmed/28644847 http://dx.doi.org/10.1371/journal.pone.0179814 Text en © 2017 Matono et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Matono, Takashi
Kutsuna, Satoshi
Kato, Yasuyuki
Katanami, Yuichi
Yamamoto, Kei
Takeshita, Nozomi
Hayakawa, Kayoko
Kanagawa, Shuzo
Kaku, Mitsuo
Ohmagari, Norio
Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia
title Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia
title_full Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia
title_fullStr Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia
title_full_unstemmed Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia
title_short Role of classic signs as diagnostic predictors for enteric fever among returned travellers: Relative bradycardia and eosinopenia
title_sort role of classic signs as diagnostic predictors for enteric fever among returned travellers: relative bradycardia and eosinopenia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482448/
https://www.ncbi.nlm.nih.gov/pubmed/28644847
http://dx.doi.org/10.1371/journal.pone.0179814
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