Intermediate clusters may cause disease in areas where dengue and malaria are present, so differential diagnosis is necessary.

Dengue is a major vector-borne infection causing large outbreaks in urban communities in tropical regions. During the period 2010- 2014; 434 serum samples from febrile patients were collected from a  semi-rural community hospital located in the norwestern region of Ecuador. Dengue virus (DENV) was investigated by reverse transcriptase PCR; a total of 48 samples were positive for dengue. During our study we detected  DENV-2 and DENV-3 from 2010 to 2013 and the four  DENV  serotypes during the period 2013-2014.  Surprisingly, our results contrasted with surveys carried out in urban centers throughout the  Ecuadorian Coast in which  DENV-1, DENV-2 and DENV-4 were prevalent during years 2010-2013 and only 2 serotypes  (DENV-1 and DENV-2) in 2014.These results suggest  that dengue viruses in semi-rural communities didn’t  originate in the Ecuadorian cities.

Discharge or follow up of confirmed coronavirus disease 2019 (COVID-19) cases depend on accurate interpretation of RT-PCR. Currently, positive/negative interpretations are based on amplification instead of quantification of cycle threshold (Ct) values, which could be used as proxies of patient infectiousness. Here, we measured Ct values in hospitalized confirmed COVID-19 patients at different times and its implications in diagnosis and follow up.Patients and Methods: Observational study between March 17th-May 12th, 2020 using multiple RT-PCR testing. A cohort of 118 Hispanic hospitalized patients with confirmed COVID-19 diagnosis in a reference hospital in Quito, Ecuador. Multiple RT-PCR tests were performed using deep nasal swab samples and the assessment of SARS-CoV-2 genes N, RdRP, and E. Results: Patients' median age was of 49 years (range: 24-91) with a male majority (62.7%). We found increasing levels of Ct values in time, with a mean Ct value of 29.13 (n = 61, standard deviation (sd) = 5.55) for the first test and 34.38 (n = 60, sd = 4), 35.52 (n = 20, sd = 2.85), and 36.12 (n = 6, sd = 3.28), for the second, third, and fourth tests, respectively. Time to RT-PCR lack of amplification for all tests was of 34 days while time to RT-PCR Ct values >33 was of 30 days. Conclusion:Cycle thresholds can potentially be used to improve diagnosis, management and control. We found that turnover time for negativity can be large for hospitalized patients and that 11% cases persisted with infectious Ct values for more time than the current isolation recommendations.