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Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana

OBJECTIVE: Leptospirosis and dengue fever (DF) are hard-to-differentiate diseases in cocirculating areas, especially during DF epidemics. Misdiagnosis and ensuing lack of antibiotic therapy can be detrimental in leptospirosis. The objective of this study was to identify factors that help differentia...

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Autores principales: Le Turnier, Paul, Bonifay, Timothée, Mosnier, Emilie, Schaub, Roxane, Jolivet, Anne, Demar, Magalie, Bourhy, Pascale, Nacher, Mathieu, Djossou, Félix, Epelboin, Loïc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735690/
https://www.ncbi.nlm.nih.gov/pubmed/31660403
http://dx.doi.org/10.1093/ofid/ofz323
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author Le Turnier, Paul
Bonifay, Timothée
Mosnier, Emilie
Schaub, Roxane
Jolivet, Anne
Demar, Magalie
Bourhy, Pascale
Nacher, Mathieu
Djossou, Félix
Epelboin, Loïc
author_facet Le Turnier, Paul
Bonifay, Timothée
Mosnier, Emilie
Schaub, Roxane
Jolivet, Anne
Demar, Magalie
Bourhy, Pascale
Nacher, Mathieu
Djossou, Félix
Epelboin, Loïc
author_sort Le Turnier, Paul
collection PubMed
description OBJECTIVE: Leptospirosis and dengue fever (DF) are hard-to-differentiate diseases in cocirculating areas, especially during DF epidemics. Misdiagnosis and ensuing lack of antibiotic therapy can be detrimental in leptospirosis. The objective of this study was to identify factors that help differentiate acute leptospirosis from dengue fever on admission. METHOD: Patients with leptospirosis (positive serology or polymerase chain reaction) were compared with patients with DF (positive nonstructural 1 [NS1] antigen) in a case-control study with age matching. Data on admission were compared using bivariate analysis and multivariate analysis. RESULTS: Seventy-two patients with leptospirosis were compared to 216 patients with DF. In bivariate analysis, the factors associated with leptospirosis were male gender, cough, anemia, and elevated blood levels of C-reactive protein (CRP), leukocytes, creatinine, bilirubin, and creatine phosphokinase. Exanthema, purpura, myalgia, headache, and neutropenia were associated with DF. In multivariate analysis, elevated blood levels of leukocytes, bilirubin, and CRP were associated with leptospirosis. The CRP threshold of 50 mg/L taken alone had elevated sensitivity and specificity. CONCLUSIONS: The CRP level, an easy-to-obtain biomarker, was a powerful tool to differentiate on admission leptospirosis and DF. Facing a dengue-like syndrome in cocirculating areas and awaiting new specific rapid diagnostic tests, CRP dosing could help the clinician to promptly consider the diagnosis of leptospirosis and initiate antibiotic therapy early.
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spelling pubmed-67356902019-09-16 Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana Le Turnier, Paul Bonifay, Timothée Mosnier, Emilie Schaub, Roxane Jolivet, Anne Demar, Magalie Bourhy, Pascale Nacher, Mathieu Djossou, Félix Epelboin, Loïc Open Forum Infect Dis Major Article OBJECTIVE: Leptospirosis and dengue fever (DF) are hard-to-differentiate diseases in cocirculating areas, especially during DF epidemics. Misdiagnosis and ensuing lack of antibiotic therapy can be detrimental in leptospirosis. The objective of this study was to identify factors that help differentiate acute leptospirosis from dengue fever on admission. METHOD: Patients with leptospirosis (positive serology or polymerase chain reaction) were compared with patients with DF (positive nonstructural 1 [NS1] antigen) in a case-control study with age matching. Data on admission were compared using bivariate analysis and multivariate analysis. RESULTS: Seventy-two patients with leptospirosis were compared to 216 patients with DF. In bivariate analysis, the factors associated with leptospirosis were male gender, cough, anemia, and elevated blood levels of C-reactive protein (CRP), leukocytes, creatinine, bilirubin, and creatine phosphokinase. Exanthema, purpura, myalgia, headache, and neutropenia were associated with DF. In multivariate analysis, elevated blood levels of leukocytes, bilirubin, and CRP were associated with leptospirosis. The CRP threshold of 50 mg/L taken alone had elevated sensitivity and specificity. CONCLUSIONS: The CRP level, an easy-to-obtain biomarker, was a powerful tool to differentiate on admission leptospirosis and DF. Facing a dengue-like syndrome in cocirculating areas and awaiting new specific rapid diagnostic tests, CRP dosing could help the clinician to promptly consider the diagnosis of leptospirosis and initiate antibiotic therapy early. Oxford University Press 2019-07-08 /pmc/articles/PMC6735690/ /pubmed/31660403 http://dx.doi.org/10.1093/ofid/ofz323 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Le Turnier, Paul
Bonifay, Timothée
Mosnier, Emilie
Schaub, Roxane
Jolivet, Anne
Demar, Magalie
Bourhy, Pascale
Nacher, Mathieu
Djossou, Félix
Epelboin, Loïc
Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana
title Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana
title_full Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana
title_fullStr Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana
title_full_unstemmed Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana
title_short Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana
title_sort usefulness of c-reactive protein in differentiating acute leptospirosis and dengue fever in french guiana
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735690/
https://www.ncbi.nlm.nih.gov/pubmed/31660403
http://dx.doi.org/10.1093/ofid/ofz323
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