Lactantes menores de 3 meses hospitalizados por síndrome febril agudo: Experiencia clínica de 5 años / Children less than 3 months hospitalised due to acute febrile syndrome: 5 years clinical experience

Introducción: La fiebre aguda de origen no precisado (FAONP) es planteada cuando la anamnesis y el examen físico no permiten identificar la causa. En menores de 3 meses esta situación es preocupante, por el riesgo de una infección bacteriana grave. Objetivo: Describir variables clínicas y de laboratorio de pacientes con FAONP, buscando pistas para basar estudios sobre las decisiones a que da lugar este problema. Pacientes y Método: Describimos retrospectivamente una cohorte de menores de 3 meses internados en el Hospital Roberto del Río (2007-2011) por FAONP. Se revisaron las historias clínicas y se efectuó una dicotomización de los pacientes según gravedad del diagnóstico de egreso, en graves y no graves. Se compararon en estratos determinados por variables con interés clínico. Resultados: Durante el periodo de estudio se ingresaron 550 niños con FAONP. La concordancia entre gravedad al ingreso y egreso fue baja (kappa = 0,079; p = 0,26). El 23,8% de los niños fueron graves y el 76,2% no graves. En el grupo de los graves predominó la infección del tracto urinario (68,7%) y en los no graves el síndrome febril agudo (40,7%). Los niveles de corte para la proteína C reactiva, leucocitos y neutrófilos/mm³, para calcular índices fijos y variables, solo mostraron valores predictivos negativos de alguna utilidad para descartar infección bacteriana grave. Las curvas ROC con recuento de leucocitos, neutrófilos y proteína C reactiva, no ofrecen índices fijos de utilidad clínica. El 34,6% de las punciones lumbares fueron traumáticas o fallidas). Conclusiones: De acuerdo a nuestros resultados, parece evidente un exceso de hospitalizaciones, la poca utilidad de exámenes para identificar infección bacteriana grave, un alto porcentaje de punciones lumbares traumáticas o fallidas y excesos de terapias antibióticas. Se hace necesaria una revisión de criterios y procedimientos clínicos.

Introduction: Acute fever of unknown origin (AFUO) is established when the anamnesis and physical examination cannot identify the cause. In infants less than 3 months-old this is situation for concern, due to the risk of a serious bacterial infection. Objective: To describe the clinical and laboratory variable of patients with AFUO, in order to look for clues in order to base studies on the decisions arising drom this problem. Patients and Methods: A report is presented on a retrospective study conducted on a cohort of children less than three months-old admitted to the Hospital Roberto del Río (2007-2011) due to an AFUO. Clinical histories were reviewed and the patients were grouped, according to the severity of the admission diagnosis, into severe and non-severe. They were compared in strata determined by the variables of clinical interest. Resultados: A total of 550 children were admitted with AFUO during the study period. There was low agreement between the severity on admission and at discharge (kappa = 0.079; P = .26). There were 23.8% of children in the severe group and 76.2% in the non-severe group. Urinary tract infection predominated in the severe group (68.7%) and 40.7% with acute febrile syndrome in the non-severe group. The cut-off levels for C-reactive protein, white cells, and neutrophils per mm³, to calculate the fixed and variable indices, only showed negative predictive values of some use for ruling out serious bacterial infection. The ROC curves with white cell and neutrophil counts and C-reactive protein, did not provide andy fixed indices of clinical use. More than one-third (34.6%) of lumbar punctures were traumatic or failures. Conclusions: According to the results of this study, there is an obvious excess of hospital admissions, little usefulness in the examinations to identify serious bacterial infection, a high percentage lumbar punctures traumatic and lumbar punctures failures, and an excess of antibiotic treatments. A review of clinical criteria and procedures is needed.

Características clínico-epidemiológicas de pacientes con diagnóstico de fiebre de origen desconocido hospitalizados en el Servico de Infectología del Instituto Nacional de Salud del Niño, 2006-2010 / Clinical and epidemiological characteristics of patients with diagnosis of fever of unknown origin hospitalized in the Service of Infectious Diseases at the National Institute of Child Health, 2006-2010

Candela Herrera, Jorge Luis Objetivos: Describir las características clínico-epidemiológicas de pacientes con diagnóstico de Fiebre de Origen Desconocido hospitalizados en el Servicio de Infectología del Instituto Nacional de Salud del Niño, 2006-2010. Material y métodos: Estudio retrospectivo, se incluyeron a todos los pacientes de 1 mes a 17 años, 11meses 29 días con diagnóstico de Fiebre de Origen Desconocido. Resultados: El grupo etáreo más comprometido fue los menores de un año (49 por ciento), en el 40 por ciento de los pacientes la etiología de la FOD no se pudo determinar. En el 51 por ciento de los pacientes la causa fue infecciosa, de este grupo el diagnóstico más común fue la enfermedad por arañazo de gato (8 por ciento) y la infección urinaria (7 por ciento). En el 77 por ciento de los casos la enfermedad se auto limitó o remitió con el tratamiento empírico. Conclusiones: Existió un alto porcentaje de casos en los cuales el diagnóstico no se pudo determinar (40 por ciento), esto reflejaría deficiencias en la complejidad de pruebas de apoyo necesarias para un adecuado diagnóstico en nuestro país. Coincidiendo con la bibliografía internacional las enfermedades infecciosas fueron las causas más comunes de FOD en los niños evaluados.

Objectives: To describe the clinical epidemiological characteristics of hospitalized patients diagnosed with fever of unknown origin at the Instituto Nacional de Salud del Niño Infectious Disease Ward, 2006-2010. Methods: Retrospective study; patients from ages 1 month to 17 years, 11 months and 29 days and diagnosed with fever of unknown origin were included. Results: The largest age group was comprised by those younger than one year of age (49 per cent); in 40 per cent of patients, the etiology of FUO could not be determined. In 51 per cent of patients, the cause was from infectious origin. From this group, the most common diagnosis was cat scratch disease (8 per cent) and urinary tract infection (7 per cent). 77 per cent of cases autolimited or remitted with empirical treatment. Conclusion: There was a high percentage of cases in which a clear diagnosis could not be determined (40 per cent); this reflects the deficiencies in the complexity of auxiliary laboratory tests needed in order to reach an adequate diagnosis in our country. Concurring with the international literature, infectious disease was the most common cause of FUO in children.

Syndromic surveillance: etiologic study of acute febrile illness in dengue suspicious cases with negative serology. Brazil, Federal District, 2008 / Vigilância sindrômica: estudo etiológico de doenças febris agudas a partir dos casos suspeitos de dengue com sorologia não reagente. Distrito Federal, Brasil, 2008

With the aim of identifying the etiology of acute febrile illness in patients suspected of having dengue, yet with non reagent serum, a descriptive study was conducted with 144 people using secondary serum samples collected during convalescence. The study was conducted between January and May of 2008. All the exams were re-tested for dengue, which was confirmed in 11.8 percent (n = 17); the samples that remained negative for dengue (n = 127) were tested for rubella, with 3.9 percent (n = 5) positive results. Among those non reactive for rubella (n = 122), tests were made for leptospirosis and hantavirus. Positive tests for leptospirosis were 13.9 percent (n = 17) and none for hantavirus. Non reactive results (70.8 percent) were considered as Indefinite Febrile Illness (IFI). Low schooling was statistically associated with dengue, rubella and leptospirosis (p = 0.009), dyspnea was statistically associated with dengue and leptospirosis (p = 0.012), and exanthem/petechia with dengue and rubella (p = 0.001). Among those with leptospirosis, activities in empty or vacant lots showed statistical association with the disease (p = 0.013). Syndromic surveillance was shown to be an important tool in the etiologic identification of IFI in the Federal District of Brazil.

Com o objetivo de identificar a etiologia de doenças febris agudas, em suspeitos de dengue com sorologia não reagente, realizou-se estudo descritivo com 144 pessoas utilizando amostras de soro coletados na convalescença, entre janeiro e março de 2008. Todos os exames foram re-testados para dengue, sendo as amostras negativas, processadas para rubéola (n = 127). Dentre as não reagentes para rubéola, submeteu-se ao teste para leptospirose (n = 122), e em se permanecendo sem diagnóstico, testou-se para hantavirose. Confirmou-se dengue em 11,8 por cento (n = 17), rubéola em 3,9 por cento (n = 5) e leptospirose em 13,9 por cento (n = 17). Os resultados não reagentes foram considerados como doença febril aguda indiferenciada (DFI) em 70.8 por cento dos casos. Verificou-se associação estatística em baixa escolaridade nos casos de dengue, rubéola e leptospirose (p = 0,009), assim como dispnéia para dengue e leptospirose (p = 0,012), e exantema/petéquias para dengue e rubéola (p = 0,001). Dentre os doentes com leptospirose, as atividades em terreno baldio mostraram-se com diferença estatística significante (p = 0,013). A vigilância sindrômica demonstrou-se como importante ferramenta na identificação de doenças febris agudas no Distrito Federal.

Fever of unknown origin: 98 cases from Saudi Arabia

Fever of unknown origin [FUO] is mainly secondary to infectious, neoplastic or inflammatory diseases. To increase the body of knowledge on this diagnosis in the region, we collected information on all patients admitted to our institution with FUO in a 13-year period. We conducted a retrospective chart review of all immunocompetent males and females aged 13 years and older admitted between January 1995 and June 2008 who fulfilled the criteria for FUO. Data collection included demographics, laboratory investigations, imaging studies, procedures and discharge diagnoses. For true FUO, we recorded the duration of follow-up and the outcome. The 98 patients who met the criteria included 44 males and 54 females with a mean [SD] age of 41.3 [18.5] years and range of 14 to 85 years. The most frequent diagnostic etiology was infectious in 32 [32.7%]. Seventeen [17.3%] patients were undiagnosed or had true FUO. Of 9 patients followed up, 8 recovered and 1 expired. The mean duration of follow-up was 20.6 months [range, 0-168 months]. Infectious diseases, especially TB, continue to be the leading etiology of FUO in our area. Our data did not identify any predictor of certain FUO diagnoses except for older age and neoplastic etiology. True FUO patients generally did well. Reporting local experience is important in guiding clinicians about the epidemiologic patterns of FUO in their regions

Leptospirosis among patients with pyrexia of unknown origin in a hospital in Guwahati, Assam.

Leptospirosis is one of the important zoonoses of man and animals. In recent years, it has increasingly been reported from different parts of the world including India. Sera from 536 individuals with pyrexia of unknown origin (PUO) belonging to different age group, sex and occupation and having varying levels of exposure to animals, forest and flood were examined for the presence of antibodies to pathogenic Leptospira by commercially available kit. Overall 22.57% individuals with PUO were found to be positive for leptospirosis with 27.93% among male and 11.79% among female patients. This difference among..genders was statistically significant. The seropositivity was higher among patients in the age groups of 21-30 years followed by 31-40 and 41-50 years. Seropositivity was higher among individuals having contact with animals, working in forest and flood affected areas.

Fiebre postoperatoria en cirugía ortopédica y urológica / Postoperative fever in orthopedic and urologic surgery

La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El 14% (42/303) de los pacientes tuvieron fiebre postoperatoria. En el 81% (34/42) su etiología fue no infecciosa y en el 19% (8/42) infecciosa. Su origen fue siempre no infeccioso dentro de las primeras 48 horas del postoperatorio (p<0.001). A 19 pacientes con fiebre después de las 48 horas y examen clínico normal, se les realizó radiografía de tórax, hemocultivos (2) y cultivo de orina. Las radiografías de tórax fueron normales en todos los casos, fueron positivos 4 urocultivos (21%, IC 95%: 6-45) y un hemocultivo (5%, IC 95%: 0.1-26). Siete pacientes tuvieron infecciones postoperatorias sin fiebre. La causa de fiebre postoperatoria más frecuente fue no infecciosa, causada por respuesta normal inflamatoria al trauma quirúrgico. La realización de estudios de rutina en pacientes con examen clínico normal y fiebre posterior a las 48 horas, de acuerdo a lo observado en este estudio, no permite sacar conclusiones definitivas. El diagnóstico de las infecciones postoperatorias se basó en el seguimiento clínico- quirúrgico y en la interpretación de los síntomas y signos del paciente.

Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p<0.001). An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n=19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.

Evaluation of the incidence of occult bacteremia among children with fever of unknown origin

We reviewed the incidence of occult bacteremia, to identify the most frequent etiological agents of bacteremias in otherwise healthy children from one month to 10 years old, who had fever of unknown origin attended at the emergency ward of an urban, university-affiliated pediatric referral center. This was a retrospective medical record review, evaluating children with fever. Data were collected from the initial visit, when blood cultures, hematological properties and hemosedimentation rates were examined. Fever was considered as the highest temperature assessed in the hospital or reported by the responsible adult. Occult bacteremia was discovered in 1.4 percent of the 1,051 children evaluated, and the most common etiologic agent was Streptococcus pneumoniae. Total leukocyte count and blood sedimentation rates greater than 30 mm³ were not predictive factors for occult bacteremia. Fever greater than 39°C was the most important factor for predicting occult bacteremia (P<0.001). The presence of occult bacteremia was significantly correlated with patient hospitalization.

Classical fever of unknown origin (FUO): current causes in Mexico / Fiebre de origen indeterminado (FOI): causas actuales en México

Background. Causes of FUO change according to medical innovations, modifications of social circumstances, and emerging health risks. Aim. To describe the epidemiology of classical FUO, the time and procedures to achieve a definitive diagnosis, and to underline the variables useful in distinguishing FUO categories. Setting. A third-referral center in Mexico City. Methods. Patients admitted with prolonged fever were evaluated. Clinical charts of patients with classical FUO were assessed; comparisons between classical FUO categories were made. Results. 45 patients with 44.9 ± 17.2 years of age, previous fever duration of 51.2 ± 51.5 days, and 88.9% referred from other hospitals were evaluated. Nineteen patients had infectious causes; eight, neoplastic conditions; 12, inflammatory non-infectious diseases; one had another cause, and five were discharged with no etiologic diagnosis. Age, LDH levels, length of fever, and weight loss greater than 10 kg may be used to classify patients into a definite category. Conclusions. Classical FUO is an unusual presentation of frequent infectious diseases; SLE is the main cause within the inflammatory non-infectious conditions, and non-Hodgkin's lymphoma is the first cause of cancer. Some clinical and laboratory clues may be used to guide the study work up of patients with classical FUO.

Las causas de fiebre de origen indeterminado (FOI) varían de acuerdo con las innovaciones médicas o con modificaciones de las circunstancias sociales y riesgos para la salud. Objetivo. Describir la epidemiología de la FOI, el tiempo y procedimientos empleados para alcanzar un diagnóstico definitivo y evaluar las variables que pueden usarse para diferenciar sus categorías. Hospital. Centro de referencia de tercer nivel de la ciudad de México. Métodos. Se evaluó a pacientes con fiebre prolongada; los expedientes clínicos de aquellos con FOI fueron analizados y se compararon sus principales categorías. Resultados. Fueron evaluados 45 pacientes, de 44 ± 17.2 años de edad y duración promedio de la fiebre de 51.2 ± 51.5 días, de los cuales 88.9% habían sido referidos de otros hospitales. De ellos, 19 fueron diagnosticados con causas infecciosas, ocho con enfermedades neoplá-sicas, 12 con enfermedades inflamatorias no infecciosas, uno por alguna otra causa y cinco fueron dados de alta sin diagnóstico definitivo. La edad, niveles de DHL, la duración de la fiebre y la pérdida de peso mayor de 10 kg fueron marcadores útiles para clasificar a los pacientes en alguna de las categorías de la FOI. Conclusiones. La FOI es una manifestación inusual de enfermedades infecciosas frecuentes, el lupus erítematoso generalizado es la causa principal dentro de las condiciones inflamatorias no infecciosas y el línfoma no-Hodgkin en las neoplásicas. Algunas pistas clínicas y de laboratorio pueden emplearse para guiar el estudio de pacientes con FOI clásica.

Investigación de un brote de fiebre de origen desconocido en una localidad colombiana del Caribe / Research of an outbreak of fever of unknown origin in a small locality in the Caribbean coast of Colombia

OBJETIVO: Realizar un estudio serológico de un brote de fiebre tropical de origen desconocido (FOD) en una zona del departamento de Córdoba, donde hay agentes etiológicos comunes de la región como Plasmodium, Leptospira, Rickettsia, Salmonella, Brucella y Orienta. MATERIALES Y MÉTODOS: En el municipio de Chimá (Córdoba) se presentó un brote de FOD. Los casos se recopilaron de un grupo de 209 pacientes sintomáticos que asistieron a la consulta. De ellos, en 89 (42.6/100) se obtuvo información clínica, epidemiológica y exámenes paraclínicos. Para establecer la causa de la FOD, se hicieron estudios serológicos y de laboratorio para leptospirosis, dengue, salmonelosis, rickettsiosis, Orienta, brucelosis y malaria. RESULTADOS: Los siguientes síntomas y signos se presentaron en 30.4/100 del total de la población estudiada: cefalea (66/100), artralgias (40/100) fiebre y cefalea (62.9/100). A pesar de serologías positivas para Rickettsia, Salmonella y Leptospira, se consideró que la causa de la FOD en la población fue una infección aguda producida por un flavivirus y que se sospechó como dengue. La positividad de anticuerpos anti-dengue IgM fue en 45/100 de los casos (40/89). La IgG se encontró en 89/100 de los pacientes antes negativos para IgM. Además, 44/100 de los pacientes fueron positivos para IgG e IgM; 30/100 de los casos se presentaron asociados con Leptospira (n=8), pero no se pudo determinar si estas infecciones fueron recientes o pasadas. CONCLUSIÓN: Después de un estudio epidemiológico, serológico y de laboratorio de siete enfermedades tropicales, se estableció que el brote de FOD se debió presumiblemente al virus de dengue

Frequency of leptospirosis in patients of acute febrile illness in Uttar Pradesh.

OBJECTIVE: This study was performed to asses the disease burden of leptospirosis in and around Lucknow among patients presenting with acute febrile illness and conforming to the case definition of leptospirosis. METHODS: A total of 346 serum samples (mostly paired) and an equal number of urine samples were collected from patients presenting with acute febrile illness and fulfilling the criteria of clinical diagnosis of leptospirosis from January 2001 to December 2001. Patients attending a tertiary care hospital as well as from various communities in and around Lucknow were included in this study. All sera and urine samples were tested for the presence of IgM antibody by Leptodipstick test and by dark-field microscopy (DFM) respectively. All positive and 10% negative sera were tested at national leptospirosis reference centre at Andaman and Nicobar Islands for microagglutination test (MAT). RESULTS: IgM antibody was detected in 25/346 (7%) patients ranging in age from 9-65 years. DFM was positive in only in one case. MAT was positive in 4/17 cases tested and the prevalent serogroups were L. grippotyphosa and L. pomona in two each. Common presenting features in these patients were fever (25/25) and jaundice (17/25). History of contact with animal or water contaminated with animal urine was present in 96% cases. CONCLUSION: Leptospirosis is not uncommon in Uttar Pradesh. However larger epidemiological studies are required to know the actual disease burden. Dark-field microscopy is an insensitive method for the diagnosis of leptospirosis and is not suitable for surveillance.

The etiology of acute pyrexia of unknown origin in children after a flood.

Acute pyrexia of unknown origin (PUO) is a major public health problem in Thailand. We studied the etiology of 180 cases of acute PUO in children after a sudden severe flood in Hat Yai city in 2000. Dengue infection and leptospirosis accounted for more than half of the total cases. Dengue hemorrhagic fever was the most common (29.4%) followed by leptospirosis (27.2%) and scrub typhus infection (1.1%). Five serovars of leptospires were involved in this study. Leptospira interrogans bataviae was the most common (86.5%). Acute serum antibody testing could detect only 52.8% and 40.8% of dengue and leptospirosis cases, respectively. This study showed both should be included in the presumptive diagnosis of acute PUO in patients after flooding.

Pyrexia of unknown origin: a prospective study of 100 cases.

AIM: There are few studies on pyrexia of unknown origin (PUO) from India. The present study was planned to elucidate the causes of in PUO Eastern India and to define the changing patterns of PUO, if any. STUDY DESIGN: Prospective case series. PATIENTS: One hundred patients meeting the classic criteria of pyrexia of unknown origin. MAIN OUTCOME MEASUREMENT: The final diagnosis established at discharge or during follow up. RESULTS: Infections, especially tuberculosis was the most dominant cause (53%), followed by neoplasms (17%), and collagen vascular disorders (11%), Miscellaneous causes were responsible in 5% cases and in 14% the cause of fever remained undiagnosed. CONCLUSION: It is concluded that infections remain the most important cause of PUO in India, confirming the trends found earlier in other studies. The incidence of neoplasms was much higher compared to other studies from India.

study on cases admitted as fever of unknown origin to Alexandria hospital [1993]

The aim of the present study was to reveal some epidemiological features of cases recorded as fever of unknown origin on admission to the hospital and to study their clinical manifestations and the received medical care. Moreover, the relation between the presenting complaints and final diagnosis among the studied cases was studied. Sheets of all cases recorded as fever of unknown origin on admission to the hospital during the period from January 1st, 1993 to the end of April 1993 were included in the study [663 cases]. The results revealed that the mean age of the total sample was 25.95 + 17.821 years with slight male predominance [1.07: 1]. Infections topped the list of causes of fever of unknown origin [94.1%], especially respiratory infection. Gastrointestinal infections, especially enteric fever, ranked the second followed by urinary tract infections. Noninfectious causes accounted for 3.8% of the cases and the cause of fever could not be determined in 2.2% of cases. The main complaints proved to have low validity in diagnosing cases. Surprisingly, only 18 cases from the total sample was found to be coincide with the stated standard definition of FUO. Many patients are placed in the FUO category because the attending physicians overlook, disregard of reject an obvious clue

Síndrome febril de difícil diagnóstico

Presentamos 38 casos de síndrome febril de difícil diagnóstico evaluados en el lapso de dos y medio años en el Hospital Militar Central de Bogotá. Se encontraron como causas más frecuentes las de origen infeccioso (52.63 por ciento), seguidas de las de origen neoplásico e inmune (15.78 por ciento) cada una. Sin diagnóstico quedaron cinco pacientes (13.15 por ciento). Se revisa el tema y se compara con trabajos nacionales y de otros paises.

Epidemic of fever of unknown origin in rural Thailand, caused by influenza A (H1N1) and dengue fever.

In the late summer (rainy season) of 1987, a sharp outbreak of fever of unknown origin (FUO) in rural southern Thailand was investigated by a field epidemiology team. In a random survey of households, 40 percent of the children and 20 percent of adults were reported to have had febrile illnesses within the last month. There was at least one death, possibly from Reye's syndrome. Testing 34 pairs of acute and convalescent sera showed significant HI antibody titer rises to influenza A (Taiwan/(H1N1) (9 cases) and dengue virus (12 cases). Testing 79 single sera with the antibody capture ELISA test for dengue, revealed that 23 percent had high titers in the IgM serum fraction suggesting recent infection. There were also six antibody titer rises to coxsackie B viruses, three from well controls. Dengue has previously been observed as a cause of FUO in rural areas in the tropics, but finding a combined epidemic of dengue and influenza was unexpected. With cooperative villagers, adequate personnel and laboratory support, especially the antigen capture ELISA test for dengue infections, it is feasible to successfully investigate disease outbreaks with serologic methods in remote villages.