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Clin Infect Dis. 2018 Dec 18. doi: 10.1093/cid/ciy1083. [Epub ahead of print]

Concomitant transmission of dengue, chikungunya and Zika viruses in Brazil: Clinical and epidemiological findings from surveillance for acute febrile illness.

Author information

1
Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
2
Instituto Nacional de Medicina Tropical, CONICET, Puerto Iguazú, Argentina.
3
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
4
University of Minnesota, St. Paul, USA.
5
Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.
6
Yale School of Public Health, New Haven, USA.
7
University of Texas Medical Branch, Galveston, USA.
8
Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
9
Emory University, Atlanta, USA.

Abstract

Background:

Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil.

Methods:

Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil between Sep/2014-Jul/2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or non-specific flavivirus (FLAV) diagnosis.

Results :

f 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV: 32, or 3.4%; CHIKV: 159, 16.7%; ZIKV: 13, 1.4%; and FLAV: 20, 2.1%), and 23 (2.4%) co-infections (DENV/CHIKV: 13, 1.4%; CHIKV/FLAV: 9, 0.9%; and DEN/ZIKV: 1, 0.1%). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with Zika presented rash (69.2%) and pruritus (69.2%) more frequently than those with dengue (37.5% and 31.2%, respectively) and chikungunya (22.9% and 14.7%, respectively) (P<0.001 for both comparisons). Conversely, arthralgia was more common in chikungunya (94.9%) and FLAV/CHIKV (100.0%) than in dengue (59.4%) and Zika (53.8%) (P<0.001). A correct presumptive clinical diagnosis was made for 9-23% of the confirmed patients.

Conclusions:

Arboviral infections are frequent causes of febrile illness. Co-infections are not rare events during periods of intense, concomitant arboviral transmission. Given the challenge to clinically distinguish these infections, there is an urgent need for rapid, point-of-care, multiplex diagnostics.

PMID:
30561554
DOI:
10.1093/cid/ciy1083

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