{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:56:02Z","timestamp":1793498162669,"version":"4.5.0"},"reference-count":45,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,11]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>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 \u226518 years enrolled May 2012\u2013January 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 (<jats:italic>N<\/jats:italic> = 303), influenza (<jats:italic>N<\/jats:italic> = 2,064), or COVID-19 (<jats:italic>N<\/jats:italic> = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1\u20133]), dengue (3 days [2\u20134]), and COVID-19 cases (4 days [2\u20137]; <jats:italic>P<\/jats:italic> &lt; 0.001). Cough (aOR: 0.12 [95% CI: 0.07\u20130.19]) and shortness of breath (0.18 [0.08\u20130.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8\u201343.5]) and thrombocytopenia (24.4 [13.3\u201345.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8\u201312.1]). 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 &gt; 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.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0149","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T13:33:16Z","timestamp":1669037596000},"page":"107-114","source":"Crossref","is-referenced-by-count":20,"title":["Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics\u2014Puerto Rico, 2012\u20132021"],"prefix":"10.4269","volume":"108","author":[{"given":"Joshua M.","family":"Wong","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah R.","family":"Volkman","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, San Juan, Puerto 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Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda C.","family":"Torres-Vel\u00e1squez","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Lorenzi","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Rivera-Amill","sequence":"additional","affiliation":[{"name":"Ponce Health Sciences University\/Ponce Research Institute, Ponce, Puerto 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