{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T12:57:10Z","timestamp":1769950630138,"version":"3.49.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009445","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000}}],"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T00:00:00Z","timestamp":1621468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Dengue fever is the most common mosquito-borne infection worldwide where an expanding surveillance and characterization of this infection are needed to better inform the healthcare system. In this surveillance-based study, we explored the prevalence and distinguishing features of dengue fever amongst febrile patients in a large community-based health facility in southern peninsular Malaysia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Over six months in 2018, we recruited 368 adults who met the WHO 2009 criteria for probable dengue infection. They underwent the following blood tests: full blood count, dengue virus (DENV) rapid diagnostic test (RDT), ELISA (dengue IgM and IgG), nested RT-PCR for dengue, multiplex qRT-PCR for Zika, Chikungunya and dengue as well as PCR tests for <jats:italic>Leptopspira<\/jats:italic> spp., Japanese encephalitis and West Nile virus.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Laboratory-confirmed dengue infections (defined by positive tests in NS1, IgM, high-titre IgG or nested RT-PCR) were found in 167 (45.4%) patients. Of these 167 dengue patients, only 104 (62.3%) were positive on rapid diagnostic testing. Dengue infection was significantly associated with the following features: family or neighbours with dengue in the past week (AOR: 3.59, 95% CI:2.14\u20136.00, p&lt;0.001), cutaneous rash (AOR: 3.58, 95% CI:1.77\u20137.23, p&lt;0.001), increased temperature (AOR: 1.33, 95% CI:1.04\u20131.70, p = 0.021), leucopenia (white cell count &lt; 4,000\/\u03bcL) (AOR: 3.44, 95% CI:1.72\u20136.89, p&lt;0.001) and thrombocytopenia (platelet count &lt;150,000\/\u03bcL)(AOR: 4.63, 95% CI:2.33\u20139.21, p&lt;0.001). Dengue infection was negatively associated with runny nose (AOR: 0.47, 95% CI:0.29\u20130.78, p = 0.003) and arthralgia (AOR: 0.42, 95% CI:0.24\u20130.75, p = 0.004). Serotyping by nested RT-PCR revealed mostly mono-infections with DENV-2 (n = 64), DENV-1 (n = 32) and DENV-3 (n = 17); 14 co-infections occurred with DENV-1\/DENV-2 (n = 13) and DENV-1\/DENV-4 (n = 1). Besides dengue, none of the pathogens above were found in patients\u2019 serum.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Acute undifferentiated febrile infections are a diagnostic challenge for community-based clinicians. Rapid diagnostic tests are increasingly used to diagnose dengue infection but negative tests should be interpreted with caution as they fail to detect a considerable proportion of dengue infection. Certain clinical features and haematological parameters are important in the clinical diagnosis of dengue infection.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009445","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T18:08:38Z","timestamp":1621534118000},"page":"e0009445","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Rapid testing requires clinical evaluation for accurate diagnosis of dengue disease: A passive surveillance study in Southern Malaysia"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9417-273X","authenticated-orcid":true,"given":"Chin Fang","family":"Ngim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed M. 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