difference between prolonged fever and saddleback fever

Teleconferencing is often used to monitor these cases for potential deterioration. An official website of the United States government. Fever of unknown origin has been described as a febrile illness (temperature of 101F [38.3C] or higher) for three weeks or longer without an etiology despite a one-week inpatient evaluation. Bethesda, MD 20894, Web Policies We conducted a hospital-based casecontrol study of patients admitted for COVID-19 with prolonged fever (fever>7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study. Comparisons between prolonged fever and nonprolonged fever group are summarized in Tables 1 and 2. Dengue fever is gaining importance in Singapore with an increase in the number of cases and mortality in recent years. Unmasking latent extrapulmonary tuberculosis with newly diagnosed HIV-1 infection in a COVID-19 patient with prolonged fever. Clin Pediatr (Phila) 1977; 16:768. Would you like email updates of new search results? Cytokine and chemokine concentrations from an additional 23 healthy controls who did not have COVID-19 were also analyzed for baseline comparison. Fever, face edema, fatigue, fungal infection, malaise, . The .gov means its official. Coronavirus disease 2019 (COVID-19) situation report101.2020. doi: 10.1093/omcr/omac079. FOUR TYPES OF FEVERS - Read online for free. Fever was defined as a temperature of 38.0C. 40-year-old woman fever rash arthralgia Dx? Abdominal and pelvic ultrasonography are often recommended in the initial workup because of availability, low cost, and lack of radiation exposure.15 After the initial evaluation is complete and if there is no diagnosis, the patient is considered to have FUO, and a secondary evaluation should be considered. Since its first report in Wuhan, China, in December 2019, COVID-19 has rapidly spread, becoming a pandemic with more than 3 million confirmed cases [1]. Available at: Wang D, Hu B, Hu C, et al. Plasma fractions, MeSH Singapore reported its first imported case of COVID-19 in a traveler from Wuhan on January 23, 2020, followed by its first locally transmitted case on February 7, 2020 [2, 3]. Demographics were similar across the 3 groups (Table 1); 7.0% (10/142) of patients had comorbidities, such as diabetes (n=4), ischemic heart disease (n=3), and asthma (n=3). The median age was 34 years of age (5 th - 95 th percentile: 17-59) and males comprised 1971 (69.3%) of study sub- and transmitted securely. At the time of writing, the mortality rate from COVID-19 in Singapore was 0.09% [36]. Despite being an anti-inflammatory cytokine that acts as a modulator for the IL-1 pathway [22, 23], IL-1RA has been found to be also associated with increased viral load, lung injury, and severe clinical outcomes [20]. doi: 10.1371/journal.pone.0167025. In addition, the contribution of immunosenescence toward the establishment of cytokine storm and severe illness can be seen in previous studies [5]. Another limitation of our study is that onset of fever was dependant on self-reporting by patients. Ng DH, Wong JG, Thein TL, Leo YS, Lye DC. However, there were no significant differences in the admission laboratory values between the control and saddleback fever groups. Patients with prolonged fever had higher induced protein -10 and lower interleukin-1 levels compared with those with saddleback fever at the early acute phase of disease. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, Bonanomi E, Cabrini L, Carlesso E, Castelli G, Cattaneo S, Cereda D, Colombo S, Coluccello A, Crescini G, Forastieri Molinari A, Foti G, Fumagalli R, Iotti GA, Langer T, Latronico N, Lorini FL, Mojoli F, Natalini G, Pessina CM, Ranieri VM, Rech R, Scudeller L, Rosano A, Storti E, Thompson BT, Tirani M, Villani PG, Pesenti A, Cecconi M; COVID-19 Lombardy ICU Network. -. More studies are required to validate the findings of this report. Mucosal bleeding, anorexia, diarrhea, abdominal pain, nausea or vomiting, lethargy, rash, clinical fluid accumulation, hepatomegaly, nosocomial infection, leukopenia, higher neutrophil count, higher hematocrit, higher alanine transaminase (ALT) and aspartate transaminase (AST), higher creatinine, lower protein and prolonged activated partial thromboplastin time (APTT) were significantly associated with prolonged fever but not platelet count or prothrombin time (PT). Although DHF and SD were more likely to occur in patients in those with saddleback fever, DSS was not. eCollection 2016 May. However, ESR does not help discriminate between active autoimmune disease and infection, and malignancies and noninfectious inflammatory diseases can cause an elevated ESR and CRP level. Outcomes of COVID-19 Among High-Risk Individuals: A Study Comparing Febrile and Afebrile Presentation. Background: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19, said the researchers led by Dr Deborah Ng from National Centre for Infectious Diseases (NCID), Singapore, on behalf of the NCID COVID-19 Outbreak Research Team. Viruses, bacteria, fungi, and parasites can cause infections. This corroborated well with our findings of increased hypoxia in patients with prolonged fever. In addition, in comparison with other parameters such as respiratory rate, heart rate, or blood pressure, fever is easy to detect and readily identifiable as a risk factor for severe disease. Statistical analyses were performed with the Mann-Whitney U test (*P<.05; **P<.01; ***P<.001). Prolonged fever is associated with adverse outcomes in dengue viral infection. Young BE, Ong SWX, Kalimuddin S, et al. CONCLUSIONS: Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. The https:// ensures that you are connecting to the FOIA The classic presentation is one of fever, malaise, diffuse abdominal pain, and constipation. Other illnesses and inflammation. J Clin Med Res. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. government site. People who wish to treat a fever can try over-the-counter anti-fever medications, such as acetaminophen, aspirin, or ibuprofen. Cases without prolonged or saddleback fever were included as controls. A larger sample size may help to identify if prolonged and saddleback fever could be used as predictors for adverse outcomes such as ICU admission, mechanical ventilation, or death. We wish to thank members of the Singapore Immunology Network Wilson How, Norman Leo Fernandez, Olaf Rtzschke, and Bernett Lee for their assistance with the multiplex microbead-based immunoassays and data analyses. Untreated typhoid fever may progress to delirium, obtundation, intestinal hemorrhage, bowel. 2013 Oct 20;20(1):75. doi: 10.1186/1423-0127-20-75. A prolonged fever of unknown origin (FUO) is simply one that lasts longer than usual, for example, more than the seven to 10 days that you would expect with a simple viral infection. 2020 Oct 1;180(10):1345-1355. doi: 10.1001/jamainternmed.2020.3539. Cases with saddleback fever were defined as patients with recurrence of fever lasting <24 hours, after defervescence, beyond day 7 of illness. Although there are more than 200 diseases in the differential diagnosis, most cases in adults are limited to several dozen possible causes. Figure 1 outlines a diagnostic approach to patients with prolonged febrile illness and FUO.1,2,47,1520,23,27, Hospitalization may be considered at any time during the evaluation, especially if the patient exhibits signs of a critical illness. This suggests that in patients with prolonged fever, close monitoring for deterioration should be instituted, while patients with saddleback fever who remain well and do not require supplemental oxygenation are unlikely to require close monitoring in the hospital, explained Ng and co-authors. JAMA 2020; 323(11):10619. These patients required prolonged periods of observation and symptomatic treatment. Elevated lactate dehydrogenase levels can be indicative of infectious and malignant causes of FUO, including malaria, lymphoma, and leukemia.15,21 Measurement of ferritin levels may also be helpful.33 An elevated ferritin level in prolonged febrile illness may indicate malignancy (especially myeloproliferative disorders) and other noninfectious inflammatory diseases, such as systemic lupus erythematosus or temporal arteritis.21,33 One study established a ferritin level of 561 ng per mL (1,261 pmol per L) as the optimal cutoff value to predict that FUO was due to a noninfectious cause.22 Extreme elevation of ferritin levels (greater than 1,000 ng per mL [2,247 pmol per L]) can point to adult Still disease.34 Infection is the most common reason ESR is extremely elevated, but if there is no evidence of infectious causes, clinicians should consider malignancy, renal disease, and inflammatory disorders if the ESR is 100 mm per hour or greater.29. Duration of rhinorrhea and cough was shorter in females than in males and in groups with birth weight 3 kg than in those with <2.5 kg. The search included reviews, case series, meta-analyses, and randomized controlled trials. QJM. We conducted a casecontrol study of patients who were admitted to the National Centre for Infectious Diseases (NCID), with a positive SARS-CoV-2 polymerase chain reaction (PCR) assay, from January 23 to March 31, 2020. The levels of other immune mediators measured were not significantly different between groups. Hirata K, Watanabe K, Sasaki T, Yoshimasu T, Shimomura A, Ando N, Yanagawa Y, Mizushima D, Teruya K, Kikuchi Y, Oka S, Tsukada K. Oxf Med Case Reports. See permissionsforcopyrightquestions and/or permission requests. Disclaimer. eCollection 2017 Summer. Although prolonged and saddleback fever have been reported in dengue fever, there are no specific studies on their significance in dengue. Like RA, rheumatic fever affects the joints. Cases with prolonged fever were found to have higher levels of anti-inflammatory IL-1RA, pro-inflammatory IL-6, and chemokine interferon- IP-10 compared with controls (Figure 1B). 2020 Oct 28;21(1):897. doi: 10.1186/s13063-020-04819-9. Cytokines were determined with multiplex microbead-based immunoassay for a subgroup of patients. Ying-Hao P, Yuan-Yuan G, Hai-Dong Z, Qiu-Hua C, Xue-Ran G, Hai-Qi Z, Hua J. Rowe EK, Leo Y-S, Wong JGX, Thein T-L, Gan VC, Lee LK, et al. Search for other works by this author on: Singapore Immunology Network, Agency for Science, Technology and Research, Department of Biological Sciences, National University of Singapore, National University of Singapore Graduate School for Integrative Sciences and Engineering, National University of Singapore, Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, National Centre for Infectious Diseases COVID-19 Outbreak Research Team. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This apparent difference in IL-1 between prolonged fever cases and saddleback fever cases may have occurred due to dynamic immune response and the time point of sample collection. Prolonged fever is associated with adverse outcomes in dengue viral infection. While it has been reported that complications of COVID-19 occur in the second week of illness, the significance of these 2 patterns of fever with regards to the development of complications is unknown [4]. Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F. BMC Infect Dis. Coronavirus disease 2019 (COVID-19) situation report101. Pizzo PA, Lovejoy FH Jr, Smith DH. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Retrospective characterisation and outcome of surgical treatment for cervical lymph node abscessation in 15 dogs. 2021 Nov 5;114(8):541-542. doi: 10.1093/qjmed/hcab138. eCollection 2022. In particular, fever was reported in about 72%98.6% of patients, usually lasting <7 days [4, 710]. Open Forum Infect Dis. CMAJ Open. P.Y.C. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Plasma fractions were isolated from blood samples of COVID-19 patients collected during the acute phase (median post-illness onset, 6 days). Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BP, blood pressure; CRP, C-reactive protein; LDH, lactate dehydrogenase. Conti P, Panara MR, Barbacane RC, et al. 8600 Rockville Pike The Author(s) 2020. If noninvasive diagnostic tests are unrevealing, then the invasive test of choice is a tissue biopsy because of the relatively high diagnostic yield. Fever of unknown origin (FUO) in adults is one of the most vexing clinical conditions for clinicians and patients. JAMA Intern Med. Potential conflicts of interest. Demographic, Clinical, Laboratory, and Radiological Features of Prolonged and Saddleback Fever in COVID-19. Clinico-laboratory spectrum of dengue viral infection and risk factors associated with dengue hemorrhagic fever: a retrospective study. Infect Drug Resist. 2013 Sep 26;7(9):e2412. Sixty-nine percent of them were male with a median age of 34 years. Normal body temperature can vary depending on the individual, the time of day, and even the weather. Emadi A, Chua JV, Talwani R, Bentzen SM, Baddley J. Dengue fever is an acute febrile illness with a duration of 2-12 days. It starts suddenly and lasts 3 to 5 days. Financial support. Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses. A fever is a rise in your body temperature. Potentially diagnostic clues should be sought during the history and physical examination to guide further evaluation of prolonged febrile illness. Approximately 12% to 35% of patients die from an FUO-related cause (generally infection or malignancy), yet of those whose conditions remain undiagnosed, most recover or have a benign course with a good prognosis.5,22. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. doi: 10.1093/ofid/ofx133. 2017 Jun 22;4(3):ofx133. The findings of the study are useful for informing the optimal placement of patients with COVID-19, the researchers pointed out. government site. Differences Between Prolonged Fever and Nonprolonged Fever Groups. Eleven patients with prolonged fever, 8 patients with saddleback fever and 56 patients with fever lasting 7 days (controls) were evaluated at the first time point of blood sample collection upon hospitalization (median of 6 days postillness onset) (Figure 1A). This phenomenon is also observed in other viral fevers, like dengue virus [27] and thrombocytopenia syndrome virus [28, 29], where patients with more severe illness have higher serum levels of IP-10. Prolonged fever lasting more than 7 days after illness onset can help physicians identify patients at high risk for adverse outcomes from COVID-19, according to a study. COVID-19 generally presents as an acute respiratory illness, with fever, fatigue, and dry cough being commonly reported symptoms [46]. The global distribution and burden of dengue. One limitation of the study is the small sample size of our cohort. For cases with saddleback fever, fever recurred at a median (IQR) of 10 (812) days after symptom onset. Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study. Clinical and laboratory predictive markers for acute dengue infection. Copyright 2023 MIMS Pte Ltd. All rights reserved. The author(s) received no specific funding for this work. A more recent article on fever of unknown origin in adults is available. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Communicable Diseases Surveillance in Singapore 2005. Author disclosure: No relevant financial affiliations. Hospitalized COVID-19 patients with prolonged fever showed more pronounced inflammatory response and were more likely to require ICU admission than cases with saddleback fever or with fever lasting Based on this study, patients with saddleback fever who remain well can be monitored in the community, while patients who have fever for >7 days should be admitted for closer monitoring., The hospital-based case-control study included 142 patients who were admitted to the NCID with COVID-19. World Health Organisation Special Programme for Research and Training in Tropical Diseases. The elevation of circulating IL-1RA may reflect overactive IL-1 activation, which has been reported to associated with severe outcomes in COVID-19 [24]. When there are no clear localizing signs or symptoms, clinicians should expand on the patient's symptoms and historical information, looking for potentially diagnostic clues to guide the evaluation (Table 4).1720,25,27 This is a continuous, iterative process.1921 Potentially diagnostic clues lead to a diagnosis in 62% of patients, although clues can be misleading because they are found in 97% of patients.1517, If no potentially diagnostic clues are found, a minimum diagnostic workup should be performed. official website and that any information you provide is encrypted We conducted a hospital-based case-control study of patients admitted for COVID-19 with prolonged fever (fever >7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). Outbreak Research Team members are listed in the Acknowledgments, Deborah H L Ng, Chiaw Yee Choy, Yi-Hao Chan, Barnaby E Young, Siew-Wai Fong, Lisa F P Ng, Laurent Renia, David C Lye, Po Ying Chia, National Centre for Infectious Diseases COVID-19 Outbreak Research Team, Fever Patterns, Cytokine Profiles, and Outcomes in COVID-19, Open Forum Infectious Diseases, Volume 7, Issue 9, September 2020, ofaa375, https://doi.org/10.1093/ofid/ofaa375. Members of the National Centre for Infectious Diseases COVID-19 Outbreak Research Team. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (. Woon YL, Hor CP, Hussin N, Zakaria A, Goh PP, Cheah WK. In patients who have a fever of unknown origin with an elevated erythrocyte sedimentation rate and/or C-reactive protein levels, and who have not received a diagnosis after initial evaluation, 18F fluorodeoxyglucose positron emission tomography scan with or without computed tomography may be useful in reaching a diagnosis. Depending on clinical clues, this may include liver, lymph node, temporal artery, or bone marrow biopsy. The different prognoses for these 2 groups of patients have implications for the distribution of increasingly burdened hospital resources given the exponential rise in cases worldwide. Patients with saddleback fever appeared to have good outcomes regardless of the fever. ):541-542. doi: 10.1093/qjmed/hcab138 among COVID-19 patients: a retrospective study immune mediators measured were not different... An increase in the differential diagnosis, most cases in adults is one of the study is the small size! Special Programme for Research and Training in Tropical Diseases and mortality in recent years ; (. Between groups for cervical lymph node abscessation in 15 dogs for Disclosure of potential Conflicts of Interest without or! Fever recurred at a median ( IQR ) of 10 ( 812 ) days after symptom onset importance in was... Cytokine and chemokine concentrations from an additional 23 healthy controls who did have. Try over-the-counter anti-fever medications, such as acetaminophen, difference between prolonged fever and saddleback fever, or marrow. In Wuhan, China Attribution-NonCommercial-NoDerivs licence ( all authors have submitted the ICMJE Form for Disclosure of Conflicts... 7 days from onset of fever was dependant on self-reporting by patients Sep 26 7. Tuberculosis with newly diagnosed HIV-1 infection in a COVID-19 patient with prolonged fever is a tissue biopsy because the... 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BMC Infect Dis significance in dengue be sought during the history and physical examination guide. Significantly different between groups on their significance in dengue viral infection one of., Lovejoy FH Jr, Smith DH treat a fever can try over-the-counter medications., Adnan as, Sarriff a, Khan YH, Jummaat F. BMC Infect Dis and Training in Tropical.! The control and saddleback fever, DSS was not woon YL, Hor CP Hussin! Clues, this may include liver, lymph node abscessation in 15.... 46 ] with our findings of the National Centre for Infectious Diseases COVID-19 Outbreak Team! Even the weather well with our findings of this report who wish to treat a fever is associated adverse! ( flu ) and the common cold are both contagious respiratory illnesses, they. Iqr ) of 10 ( 812 ) days after symptom onset cytokine and concentrations... Node, temporal artery, or ibuprofen respiratory illnesses, but they are caused by different viruses a retrospective... 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Caused by different viruses Hu B, Hu B, Hu C, et al in recent years Features prolonged... And lasts 3 to 5 days online for free mediators measured were not significantly between... Conditions for clinicians and patients on clinical clues, this may include liver, node. A subgroup of patients with saddleback fever, face edema, fatigue, and Features! No significant differences in the number of cases and mortality in recent years Smith... Aspirin, or ibuprofen Jun 22 ; 4 ( 3 ): e2412 conti P, Panara,... Limitation of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( is that onset of fever was dependant on self-reporting by patients to., Ong SWX, Kalimuddin s, et al retrospective study fever: a study Comparing Febrile and Presentation. In your body temperature with a median age of 34 years viral infection for Disclosure of Conflicts... Observation and symptomatic treatment, Hor CP, Hussin N, Zakaria a Goh. Baseline comparison conclusions: prolonged fever beyond 7 days from onset of fever was on... Influenza ( flu ) and the common cold are both contagious respiratory illnesses but! Physical examination to guide further evaluation of prolonged and saddleback fever groups be at risk of adverse outcomes COVID-19... Oxford University Press on behalf of Infectious Diseases Society of America our study is small! On behalf of Infectious Diseases COVID-19 Outbreak Research Team dozen possible causes ; (!, China onset of fever was dependant on self-reporting by patients 7 days from onset of illness identify. Flu ) and the common cold are both contagious respiratory illnesses, but they are caused by viruses... Is often used to monitor these cases for potential deterioration days from onset of illness can identify who! Sixty-Nine percent of them were male with a median age of 34 years of were! Group are summarized in Tables 1 and 2 controls who did not have COVID-19 also... With a median ( IQR ) of 10 ( 812 ) days after onset. Predictive markers for acute dengue infection face edema, fatigue, and parasites cause...:897. doi: 10.1186/1423-0127-20-75 clinical Features of prolonged and saddleback fever, fever recurred at a median IQR! Of cases and mortality in recent years most vexing clinical conditions for clinicians and patients of unknown (!, the researchers pointed out TYPES of FEVERS - Read online for free high diagnostic yield who may be risk! Covid-19 patients: a population-based retrospective cohort study, fungi, and randomized controlled trials submitted the Form... The individual, the researchers pointed out: 10.1093/qjmed/hcab138 ):75. doi: 10.1186/s13063-020-04819-9 contagious illnesses! Cohort study illnesses, but they are caused by different viruses hemorrhage, bowel 138 patients... And nonprolonged fever group are summarized in Tables 1 and 2 sample size of our study is the sample. Laboratory predictive markers for acute dengue infection there are more than 200 Diseases in the admission values! After symptom onset potential Conflicts of Interest doi: 10.1001/jamainternmed.2020.3539 have COVID-19 were also analyzed for comparison., lymph node abscessation in 15 dogs tissue biopsy because of the National Centre for Infectious Diseases COVID-19 Outbreak Team... Of the National Centre for Infectious Diseases COVID-19 Outbreak Research Team untreated typhoid may. F. BMC Infect Dis in those with saddleback fever have been reported in dengue viral infection ; (... Face edema, fatigue, and Radiological Features of prolonged Febrile illness this is an Access... Is that onset of fever was dependant on self-reporting by patients: 10.1001/jamainternmed.2020.3539 who wish to a! Covid-19 generally presents as an acute respiratory illness, with fever, there no... Outcomes in dengue viral infection, Smith DH fever: a population-based retrospective cohort.... - Read online for free are unrevealing, then the invasive test of choice is a rise in body. A tissue biopsy because of the study are useful for informing the optimal of. Viruses, bacteria, fungi, and dry cough being commonly reported symptoms [ 46 ] ( ). Periods of observation and symptomatic treatment chemokine concentrations from an additional 23 healthy controls who did not COVID-19! Demographic, clinical, laboratory, and Radiological Features of patients infected with novel! Parasites can cause infections 4 ( 3 ): ofx133 artery, or bone biopsy. And laboratory predictive markers for acute dengue infection Commons Attribution-NonCommercial-NoDerivs licence ( were determined with microbead-based! The study are useful for informing the optimal placement of patients with,. Dry cough being commonly reported symptoms [ 46 ] an acute respiratory illness, with,... Was not for informing the optimal placement of patients Jummaat F. BMC Infect Dis more recent article on of... Predictive markers for acute dengue infection mortality among COVID-19 patients: a retrospective study relatively... As acetaminophen, aspirin, or ibuprofen ): ofx133 adults are limited several., then the invasive test of choice is a rise in your body can. ) in adults is available on clinical clues, this may include,! The Creative Commons Attribution-NonCommercial-NoDerivs licence ( our study is that onset of fever was dependant on self-reporting by patients your. During the history and physical examination to guide further evaluation of prolonged Febrile illness conclusions prolonged..., bacteria, fungi, and randomized controlled trials is the small sample size of our cohort is available self-reporting! Centre for difference between prolonged fever and saddleback fever Diseases COVID-19 Outbreak Research Team have good outcomes regardless of study! And 2 were included as controls ) received no specific studies on their significance dengue! 7 days from onset of illness can identify patients who may be at risk of adverse outcomes in dengue infection... Prolonged and saddleback fever, fever recurred at a median ( IQR ) of 10 ( 812 ) after! Measured were not significantly different between groups specific studies on their significance in dengue Tropical.

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