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Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021

Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengu...

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Autores principales: Wong, Joshua M., Volkman, Hannah R., Adams, Laura E., Oliveras García, Carene, Martinez-Quiñones, Alma, Perez-Padilla, Janice, Bertrán-Pasarell, Jorge, Sainz de la Peña, Diego, Tosado-Acevedo, Rafael, Santiago, Gilberto A., Muñoz-Jordán, Jorge L., Torres-Velásquez, Brenda C., Lorenzi, Olga, Sánchez-González, Liliana, Rivera-Amill, Vanessa, Paz-Bailey, Gabriela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833087/
https://www.ncbi.nlm.nih.gov/pubmed/36410319
http://dx.doi.org/10.4269/ajtmh.22-0149
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author Wong, Joshua M.
Volkman, Hannah R.
Adams, Laura E.
Oliveras García, Carene
Martinez-Quiñones, Alma
Perez-Padilla, Janice
Bertrán-Pasarell, Jorge
Sainz de la Peña, Diego
Tosado-Acevedo, Rafael
Santiago, Gilberto A.
Muñoz-Jordán, Jorge L.
Torres-Velásquez, Brenda C.
Lorenzi, Olga
Sánchez-González, Liliana
Rivera-Amill, Vanessa
Paz-Bailey, Gabriela
author_facet Wong, Joshua M.
Volkman, Hannah R.
Adams, Laura E.
Oliveras García, Carene
Martinez-Quiñones, Alma
Perez-Padilla, Janice
Bertrán-Pasarell, Jorge
Sainz de la Peña, Diego
Tosado-Acevedo, Rafael
Santiago, Gilberto A.
Muñoz-Jordán, Jorge L.
Torres-Velásquez, Brenda C.
Lorenzi, Olga
Sánchez-González, Liliana
Rivera-Amill, Vanessa
Paz-Bailey, Gabriela
author_sort Wong, Joshua M.
collection PubMed
description Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengue compared with COVID-19. Participants with fever or respiratory symptoms and aged ≥18 years enrolled May 2012–January 2021 with dengue, influenza, or SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction were included. We calculated adjusted odds ratios (aORs) and 95% CIs using logistic regression to assess clinical characteristics of participants with COVID-19 compared to those with dengue or influenza, adjusting for age, subregion, and days from illness onset to presentation for clinical care. Among 13,431 participants, we identified 2,643 with dengue (N = 303), influenza (N = 2,064), or COVID-19 (N = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1–3]), dengue (3 days [2–4]), and COVID-19 cases (4 days [2–7]; P < 0.001). Cough (aOR: 0.12 [95% CI: 0.07–0.19]) and shortness of breath (0.18 [0.08–0.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8–43.5]) and thrombocytopenia (24.4 [13.3–45.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8–12.1]). In summary, cough, shortness of breath, facial flushing, and thrombocytopenia helped distinguish between dengue and COVID-19. Although few features distinguished influenza from COVID-19, presentation > 4 days after symptom onset suggests COVID-19. These findings may assist clinicians making time-sensitive decisions regarding triage, isolation, and management while awaiting pathogen-specific testing.
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spelling pubmed-98330872023-01-17 Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021 Wong, Joshua M. Volkman, Hannah R. Adams, Laura E. Oliveras García, Carene Martinez-Quiñones, Alma Perez-Padilla, Janice Bertrán-Pasarell, Jorge Sainz de la Peña, Diego Tosado-Acevedo, Rafael Santiago, Gilberto A. Muñoz-Jordán, Jorge L. Torres-Velásquez, Brenda C. Lorenzi, Olga Sánchez-González, Liliana Rivera-Amill, Vanessa Paz-Bailey, Gabriela Am J Trop Med Hyg Research Article Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengue compared with COVID-19. Participants with fever or respiratory symptoms and aged ≥18 years enrolled May 2012–January 2021 with dengue, influenza, or SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction were included. We calculated adjusted odds ratios (aORs) and 95% CIs using logistic regression to assess clinical characteristics of participants with COVID-19 compared to those with dengue or influenza, adjusting for age, subregion, and days from illness onset to presentation for clinical care. Among 13,431 participants, we identified 2,643 with dengue (N = 303), influenza (N = 2,064), or COVID-19 (N = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1–3]), dengue (3 days [2–4]), and COVID-19 cases (4 days [2–7]; P < 0.001). Cough (aOR: 0.12 [95% CI: 0.07–0.19]) and shortness of breath (0.18 [0.08–0.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8–43.5]) and thrombocytopenia (24.4 [13.3–45.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8–12.1]). In summary, cough, shortness of breath, facial flushing, and thrombocytopenia helped distinguish between dengue and COVID-19. Although few features distinguished influenza from COVID-19, presentation > 4 days after symptom onset suggests COVID-19. These findings may assist clinicians making time-sensitive decisions regarding triage, isolation, and management while awaiting pathogen-specific testing. The American Society of Tropical Medicine and Hygiene 2023-01 2022-11-21 /pmc/articles/PMC9833087/ /pubmed/36410319 http://dx.doi.org/10.4269/ajtmh.22-0149 Text en © The author(s) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License (https://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
Wong, Joshua M.
Volkman, Hannah R.
Adams, Laura E.
Oliveras García, Carene
Martinez-Quiñones, Alma
Perez-Padilla, Janice
Bertrán-Pasarell, Jorge
Sainz de la Peña, Diego
Tosado-Acevedo, Rafael
Santiago, Gilberto A.
Muñoz-Jordán, Jorge L.
Torres-Velásquez, Brenda C.
Lorenzi, Olga
Sánchez-González, Liliana
Rivera-Amill, Vanessa
Paz-Bailey, Gabriela
Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021
title Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021
title_full Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021
title_fullStr Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021
title_full_unstemmed Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021
title_short Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics—Puerto Rico, 2012–2021
title_sort clinical features of covid-19, dengue, and influenza among adults presenting to emergency departments and urgent care clinics—puerto rico, 2012–2021
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833087/
https://www.ncbi.nlm.nih.gov/pubmed/36410319
http://dx.doi.org/10.4269/ajtmh.22-0149
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