Clinical characteristics and predictive score of dengue vs. chikungunya virus infections

Background. - Chikungunya (CHIKV) and dengue viruses (DENY) are two arboviruses with epidemic potential and similar clinical presentations. The potential life-threatening risk associated with DENY justifies an immediate biological assessment and medical follow-up which may be delayed for CHIKV. Objectives. - To compare the clinical variables that would help differentiate patients infected with CHIKV or DENY, and then to compute a predictive score. Patients and method. - Retrospective case-control study comparing CHIKV-infected patients diagnosed by RT-PCR in 2014 with patients infected with DENY diagnosed by positive NS1 antigen test in 2013. Children aged < 15 years and pregnant women were excluded. Clinical and biological variables were compared, and a multivariate analysis was performed. A clinical score was developed using the beta coefficients to differentiate the infections. Results. - Over the study period 168 patients infected with CHIKV were compared with 452 patients with DENY. The clinical variables independently associated with CHIKV was joint and back pain, and those associated with DENY were headache, muscle pain, nausea/vomiting, diarrhea, and hemorrhagic signs. The clinical score had 98% sensitivity for DENY and a ROC curve of 0.96. Conclusion. - These two infections have a similar clinical presentation but the use of the proposed clinical score during the acute phase of the disease would make it possible to identify cases of DENY during a CHIKV epidemic to suggest adequate patient management. (C) 2018 Elsevier Masson SAS. All rights reserved.