Patterns of signs, symptoms and laboratory values associated with Zika, dengue and undefined acute illnesses in a dengue endemic region: secondary analysis of a prospective cohort study in southern México

Dengue and Zika infections cause illnesses with overlapping clinical manifestations. We aimed to explore the association of each of these infections with single or grouped clinical and laboratory parameters. We prospectively collected clinical and laboratory data from a cohort of patients seeking care for symptoms meeting the Pan American Health Organization's modified case-definition criteria for probable Zika virus infection. Zika and dengue were diagnosed with RT-PCR. We examined the relationship of clinical characteristics and laboratory data with Zika, dengue and undefined acute illness (UAI). In univariate models, localized rash and maculopapular exanthema were associated with Zika infection. Generalized rash, petechia, and petechial purpuric rash were associated with dengue. Cough and confusion/disorientation were associated with UAI. Platelets were significantly lower in the dengue group. A conditional inference tree model showed poor sensitivity and positive predictive value for individual viral diagnoses. Clusters of signs, symptoms and laboratory values evaluated in this study cannot consistently differentiate Zika or dengue cases from UAI in the clinical setting at the individual patient level. We identified symptoms that are important to Zika and dengue in univariate analyses, but predictive models were unreliable. Low platelet count was a distinctive feature of dengue. This study has been registered at ClinicalTrials.gov (NCT02831699). Copyright © 2020. Published by Elsevier Ltd.

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