744. Incidence and Duration of Diagnostic Delays Associated with Dengue Fever

Abstract Background Dengue fever is a prominent emerging arboviral infection in the tropics and subtropics, and an important cause of systemic febrile illness among some international travelers. Signs and symptoms are similar to more common infectious illnesses in temperate climates, and dengue may not be promptly considered when patients seek evaluation. Methods We conducted a retrospective cohort study of patients diagnosed with dengue fever using the IBM MarketScan Research database from 2001-2017. We identified cases of dengue fever where patients were enrolled ≥ 1 year prior to the index diagnosis. All healthcare visits in the year prior to the index diagnosis were collected and we identified visits with signs/symptoms compatible with dengue or a diagnosis made of an illness with similar symptoms (e.g., influenza) before the index dengue diagnosis. We used a time-series change-point analysis to identify the time before diagnosis in which symptoms of dengue became more prominent. We conducted a bootstrap-based simulation analysis to estimate the duration and frequency of missed diagnostic opportunities. Results We identified 4,449 cases of dengue fever that met eligibility criteria. We found that 2,791 (62.7%) had ≥ 1 healthcare visit(s) prior to diagnosis with characteristic symptoms of dengue recorded. Our simulations analysis supports that 32.9% (95% CI: 31.1-35.0) experienced 1 or more missed opportunities for diagnosis. Among these patients, the average duration of diagnostic delay was 8.26 (CI: 6.32-11.38) days and ~21% of patients had a diagnostic delay of 2 or more weeks. Patients with a delayed diagnosis averaged 2.2 (CI 2.11-2.29) healthcare visits which represented missed opportunities. Missed opportunities were more likely during weekend, ED or outpatient visits. Conclusion Dengue fever is not considered in the majority of patients at the time of the initial symptomatic evaluation in the U.S., indicating delays in diagnosis are common. Enhanced education of providers about dengue fever could lead to more prompt diagnosis that should help optimize patient management. Disclosures All Authors: No reported disclosures

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Which triggers could support timely identification of primary antibody deficiency? A qualitative study using the patient perspective

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01918-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lisanne M. A. Janssen ◽

Kim van den Akker ◽

Mohamed A. Boussihmad ◽

Esther de Vries

Keyword(s):

Respiratory Infections ◽

Diagnostic Delay ◽

Signs And Symptoms ◽

Negative Influence ◽

Primary Antibody ◽

Emotional Impact ◽

Structured Interviews ◽

Timely Treatment ◽

The Way

Abstract Background Patients with predominantly (primary) antibody deficiencies (PADs) commonly develop recurrent respiratory infections which can lead to bronchiectasis, long-term morbidity and increased mortality. Recognizing symptoms and making a diagnosis is vital to enable timely treatment. Studies on disease presentation have mainly been conducted using medical files rather than direct contact with PAD patients. Our study aims to analyze how patients appraised their symptoms and which factors were involved in a decision to seek medical care. Methods 14 PAD-patients (11 women; median 44, range 16-68 years) were analyzed using semi-structured interviews until saturation of key emergent themes was achieved. Results Being always ill featured in all participant stories. Often from childhood onwards periods of illness were felt to be too numerous, too bad, too long-lasting, or antibiotics were always needed to get better. Recurrent or persistent respiratory infections were the main triggers for patients to seek care. All participants developed an extreme fatigue, described as a feeling of physical and mental exhaustion and thus an extreme burden on daily life that was not solved by taking rest. Despite this, participants tended to normalize their symptoms and carry on with usual activities. Non-immunologists, as well as patients, misattributed the presenting signs and symptoms to common, self-limiting illnesses or other ‘innocent’ explanations. Participants in a way understood the long diagnostic delay. They know that the disease is rare and that doctors have to cover a broad medical area. But they were more critical about the way the doctors communicate with them. They feel that doctors often don’t listen very well to their patients. The participants’ symptoms as well as the interpretation of these symptoms by their social environment and doctors had a major emotional impact on the participants and a negative influence on their future perspectives. Conclusions To timely identify PAD, ‘pattern recognition’ should not only focus on the medical ‘red flags’, but also on less differentiating symptoms, such as ‘being always ill’ and ‘worn out’ and the way patients cope with these problems. And, most important, making time to really listen to the patient remains the key.

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Frequency of Suspected and Probable Case of Dengue in Adult Febrile Patients and their Knowledge about Dengue Fever

Journal of Sheikh Zayed Medical College ◽

10.47883/jszmc.v12i02.51 ◽

2021 ◽

pp. 8-12

Keyword(s):

Dengue Fever ◽

Calculated Data ◽

Febrile Illness ◽

Sampling Technique ◽

Cross Sectional Study ◽

Medical Intervention ◽

Cross Sectional ◽

Probable Case ◽

Control Objective ◽

Dengue Prevention

Background: Febrile illness is considered a frequent medical syndrome of dengue. Due to the increasing prevalence of dengue infectivity, appropriate diagnosis among patients helps regarding timely medical intervention, etiological examination as well as disease control. Objective: To estimate the frequency of suspected and probable cases of dengue in febrile patients and their knowledge about dengue fever, presenting at outdoor of Jinnah Hospital, Lahore. Methodology: It was a cross-sectional study, in which 400 adult febrile patients visiting at outdoor of Jinnah Hospital, Lahore were included. A convenient sampling technique was carried out. Among the total febrile patients included, the frequency of suspected and probable cases was calculated. Data was collected through a questionnaire, which was entered and analyzed using SPSS version 20.0. Results: Out of 400 patients, 36.5% were 21-30 years old and 53.5% were female. Among these patients, 100% had fever (>2 and <10 days), 31.8% had headache, 51.8% had myalgia and43.8% patients had arthralgia while 12.5% were suspected cases of dengue. Majority (97.2%) had knowledge that full sleeve shirt can prevent dengue, none of the respondents had knowledge regarding dengue symptoms and 76% of respondents had knowledge that dengue is fatal. For the majority (76%) of respondents, the main source of information regarding dengue was health teams. Conclusion: The study concluded that symptoms of dengue fever in the study patients, as well as the dengue, suspected cases were mainly headache, retro-orbital pain, myalgia, and arthralgia. The majority of the patients had knowledge about dengue prevention. Most of the adult febrile as well as suspected had no knowledge about the symptomology of dengue fever.

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Four common diseases causing sudden blindness or death in the eye emergency department

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-138163 ◽

2020 ◽

pp. postgradmedj-2020-138163

Author(s):

Ana Leonor Rei da Cruz Escaleira ◽

Dimitrios Kalogeropoulos ◽

Chris Kalogeropoulos ◽

Soon Wai Ch’Ng ◽

Velota C T Sung ◽

...

Keyword(s):

Emergency Department ◽

Delayed Diagnosis ◽

Signs And Symptoms ◽

Ocular Motility ◽

Ocular Manifestations ◽

Ischaemic Attack ◽

High Index Of Suspicion ◽

Sudden Blindness ◽

Patient At Risk ◽

Prompt Diagnosis

Neuro-ophthalmological emergency disorders typically present with symptoms of visual loss, diplopia, ocular motility impairment or anisocoria. The ocular manifestations of these disorders are sometimes indicative of a more serious global neurology disease rather than an isolated ocular disease. The aim of this review is to highlight four important neuro-ophthalmological emergency disorders that must not be missed by an ophthalmologist. These include acute painful Horner’s syndrome, painful cranial nerve III palsy, giant cell arteritis and transient ischaemic attack with amaurosis fugax. The delayed diagnosis of these clinical entities puts the patient at risk of blindness or death. Therefore, prompt diagnosis and management of these conditions are essential. This can be acquired from understanding the main signs and symptoms of the disease presentation together with a high index of suspicion while working at a busy eye emergency department.

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Look granulomatosis with polyangiitis (GPA) straight in the face: missed opportunities leading to a delayed diagnosis

Autoimmunity Highlights ◽

10.1186/s13317-019-0118-4 ◽

2019 ◽

Vol 10 (1) ◽

Author(s):

N. Rolle ◽

M. Muruganandam ◽

I. Jan ◽

F. M. Harji ◽

J. Harrington ◽

...

Keyword(s):

Granulomatosis With Polyangiitis ◽

Systemic Vasculitis ◽

Delayed Diagnosis ◽

Organ System ◽

Atypical Presentation ◽

Mural Thrombus ◽

Missed Opportunities ◽

Original Diagnosis ◽

The Face ◽

High Index Of Suspicion

Abstract Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with a potential to involve any organ system. It remains an important cause of kidney related morbidity and mortality. Early diagnosis can be difficult and requires high index of suspicion in all patients, but especially in cases with atypical presentation. We report a case with GPA, which was diagnosed only after new and advancing symptoms belied the original diagnosis of bilateral facial palsy and aortic mural thrombus.

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Study of haematological, biochemical profile and clinical presentation in dengue positive patients: 82 cases

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182296 ◽

2018 ◽

Vol 6 (6) ◽

pp. 2099

Author(s):

Mubin I. Patel ◽

Abhishek Patel ◽

Avani Patel ◽

Sharmistha Patel ◽

Suresh Padsala

Keyword(s):

Dengue Fever ◽

Clinical Presentation ◽

Liver Enzymes ◽

Neglected Tropical Diseases ◽

Clinical Signs ◽

Signs And Symptoms ◽

Biochemical Profile ◽

Igg Antibody ◽

Aedes Mosquitoes ◽

Clinical Signs And Symptoms

Background: Dengue Fever (DF) is a self-limiting disease caused by arbovirus and transmitted by Aedes mosquitoes (Aedes aegypti and Aedes albopictus). It is one of the 17 neglected tropical diseases by WHO. Diagnosis of dengue depends mainly on the detection of IgM and IgG antibody, and NS1 antigen.Methods: The study was carried out in Department of Pathology, affiliated with a government hospital. It includes 82 dengue patients, admitted from August 2015 to August 2016. Haematological, biochemical profile, clinical signs and symptoms were recorded. The Tourniquet test was performed in all the patients on admission. Grading of dengue: DF/DHFI/DHFII/DHFIII/DHFIV. Grade III and IV were collectively called as Dengue Shock Syndrome.Results: Total 82 Dengue positive cases were studied, 52 (63%) were males and 30 (37%) were females. 24 (29%) patients were recorded in September 22 (27%) in October 19 (23%) in August. 12 (14.60%) had positive tourniquet test. Thrombocytopenia was present in 86.5 % patients. Majority cases were of classical dengue fever 51 (62.20%), 14 (17.07%) were of DHF I, 12 (14.63%) were of DHF II, 3 (3.66%) were of DHF III and 2 (2.44%) were of DHF IV.Conclusions: It is very important to correlate clinical examination with haematological and biochemical profile in dengue patients. Hematocrit value, leucopenia, thrombocytopenia, raised liver enzymes is very important to monitor dengue cases in their initial stages and thus facilitate early treatment. This would minimize morbidity and mortality arising out of serious complications of dengue fever.

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Differentiating Scrub Typhus, Dengue Fever and Typhoid Fever in Indian Children Presenting with Acute Febrile Illness

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v40i2.29319 ◽

2020 ◽

Vol 40 (2) ◽

pp. 93-99

Author(s):

Saheli Misra Chatterjee ◽

Suman Mondal ◽

Kaushik Mukhopadhyay ◽

Niloy Kumar Das

Keyword(s):

Dengue Fever ◽

Scrub Typhus ◽

Tertiary Care ◽

Febrile Illness ◽

Acute Febrile Illness ◽

Indian Children ◽

Diagnostic Dilemma ◽

Female Ratio ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

Introduction: The disease spectrum of dengue, scrub typhus and typhoid presenting as acute febrile illness is often a diagnostic dilemma to the clinician. The purpose of this study is to compare the clinical features and laboratory parameters of children suffering from typhoid, dengue and scrub typhus and use these parameters in early identification of scrub typhus before conclusion is made from serological diagnosis. Methods: A retrospective observational analytical study was conducted among children presenting with acute febrile illness in a tertiary care level hospital. Over the period of one year 113 cases were identified of which 39 were dengue, 44 were typhoid and 30 were scrub typhus. Results: The mean age of the children was 7.45 ± 2.98 years, median was eight with an interquartile range of six to ten years. The male to female ratio was 1.3:1. Symptoms of vomiting (61.54%), headache (46.15%) and hepatomegaly (47.37%) were significantly higher among children with dengue fever. A significantly higher number of children with scrub typhus fever had temperature above 40°C. The incidence of low haemoglobin, raised C reactive protein, raised ALT and low albumin levels were significantly higher in them. Children with acute febrile illness having temperature > 40°C, absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to suffer from scrub typhus with relative probability ratio (RPR) of 25.68 and 10.57 respectively (p < 0.001). Children with WBC < 5000/mm3 were more likely to be suffering from dengue with RPR of 10.60 (p < 0.001). Conclusion: Children with acute febrile illness with temperature > 40°C and absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to be suffering from scrub typhus.

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Herpangina: The Etiologic Spectrum

PEDIATRICS ◽

10.1542/peds.36.4.632 ◽

1965 ◽

Vol 36 (4) ◽

pp. 632-634

Author(s):

James D. Cherry ◽

Charles L. Jahn

Keyword(s):

Differential Diagnosis ◽

Febrile Illness ◽

Signs And Symptoms ◽

Enterovirus Infection ◽

Febrile Disease

The etiology of herpangitic enanthem cannot be restricted to certain Coxsackie A viruses. Zahorsky1, 2 and others3-5 considered herpangina a specific febrile disease, but in light of more recent studies6-17 and the presently reported cases, it would seem more appropriate to restrict the use of the term "herpangina" to the description of the characteristic oropharyngeal lesions. Enanthem is one of the protean manifestations of enterovirus infection and is must be included along with other signs and symptoms in the over-all differential diagnosis of summer febrile illness.

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Delayed Tuberculosis Diagnosis in a Low Incidence Country and its Effect on Cost of Care

10.21203/rs.3.rs-1138557/v1 ◽

2021 ◽

Author(s):

James O'Connell ◽

Niamh Reidy ◽

Cora McNally ◽

Debbi Stanistreet ◽

Eoghan de Barra ◽

...

Keyword(s):

Health Care ◽

Health Care Provider ◽

Care Provider ◽

Delayed Diagnosis ◽

Signs And Symptoms ◽

Cost Of Care ◽

Global Priority ◽

Low Incidence ◽

The Cost ◽

Health Care Records

Abstract Background Tuberculosis elimination (TB) is a global priority that requires high-quality timely care to be achieved. In low TB incidence countries such as Ireland, delayed diagnosis is common. Despite cost being central to policy making, it is not known if delayed care affects care cost among TB patients in a low-incidence setting. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1st 2018 and December 31st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Benchmarks against which the outcomes were compared were derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

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Risk factors associated with Dengue fever outbreak in Islamabad, Pakistan (Preprint)

10.2196/preprints.27266 ◽

2021 ◽

Author(s):

Chaudhry Amjad Mehmood ◽

Fawad Khalid Khan ◽

Zakir Hussain ◽

Mumtaz Ali Laghari ◽

Ambreen Chaudhry ◽

...

Keyword(s):

Risk Factors ◽

Dengue Fever ◽

Attack Rate ◽

Disease Surveillance ◽

Signs And Symptoms ◽

Open Water ◽

Bed Nets ◽

Stagnant Water ◽

Blood Samples ◽

Active Case

BACKGROUND On 23rd Oct 2016, 79 dengue fever cases were reported from the Union Council (UC) Tarlai to Federal Disease Surveillance and Response Unit Islamabad. A team was deputed to investigate the suspected dengue outbreak. OBJECTIVE This study was aimed to determine the extent of the outbreak and identify the possible risk factors. METHODS Active case finding was conducted through a house-to-house survey. A case was defined as, acute onset of Fever ≥ 38 ℃ in a resident of Tarlai from Oct 2-Nov 11, 2016, with a positive NS-1 test, and any two of the following signs and symptoms; retro-orbital/ocular pain, headache, rash, myalgia, arthralgia, and hemorrhagic manifestations. A structured questionnaire was used to collect data. Age and sex-matched controls (1:1) were identified from the same area. Blood samples were taken and sent to the National Institute of Health for genotype identification. RESULTS During the active case search, 145 cases of dengue fever were identified by surveying 928 houses from 23rd Oct to 11th Nov 2016. Attack rate (AR) was 17.0/10,000 population. The mean age was 34.4±14.4 years. More than half of the cases were male (n=80, 55.2%). Among all cases, 29% belong to the 25-34 years age group while the highest attack rate was found in 35-44 years (AR 35.6/10,000) followed by 55-64 years (AR 35.5/10,000). All five blood samples tested positive for NS-1 (genotype DENV-2). The most frequent presenting sin/symptom was fever and headache (100%). Stagnant water around houses (OR = 4.86, CI: 2.94 -8.01, P<0.0001), presence of flower pots in-home (OR = 2.73, CI: 1.67-4.45, P<0.0001), and open water container (OR 2.24, CI: 1.36-3.60, P<0.0001) showed higher odds among cases. While. use of bed nets (OR 0.44, CI: 0.25-0.77, P 0.003), insecticidal spray (OR 0.33, CI: 0.22-0.55, P<0.0001), door screening (OR 0.27, CI: 0.15-0.46, P<0.0001), use of mosquito coil/mat (OR 0.26, CI: 0.16-0.44, P<0.0001) and cleanliness in house (OR 0.12, CI: 0.05-0.26, P<0.0001) showed a significant protective effect. CONCLUSIONS Stagnant water acting as breeding grounds for vector was the probable cause of the spread of the outbreak. The establishment of a surveillance and early reporting system and the use of protective measures against the vector is strongly recommended.

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Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment

BJPsych Open ◽

10.1192/bjo.2019.54 ◽

2019 ◽

Vol 5 (5) ◽

Author(s):

Ditte Hoffmann ◽

Charlotte Ulrikka Rask ◽

Erik Hedman-Lagerlöf ◽

Trine Eilenberg ◽

Lisbeth Frostholm

Keyword(s):

Health Anxiety ◽

Diagnostic Delay ◽

Accurate Method ◽

Diagnostic Interview ◽

Self Report ◽

Eligibility Criteria ◽

Recruitment Methods ◽

Face To Face ◽

Symptom Profile ◽

Mean Differences

Background Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay. Aims This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment. Method Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics. Results In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile. Conclusions Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics. Declaration of interest None.

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