Abstract:Dengue and chikungunya fevers are transmitted by the common mosquito vector Aedes and malaria by Anopheles. Concurrent infections are reported due to co-circulation of these pathogens, especially in endemic regions. We report a rare case of triple infection with 3 arthropod-borne pathogens (Plasmodium vivax and the dengue and chikungunya viruses) in a 3-year-old child from New Delhi, India, in August 2016. The viruses were identified by RT-PCR and the parasite by microscopy and antigen detection. The dengue vi… Show more
“…An investigation reported concurrent infection with Plasmodium, DENV and CHIKV in a traveler from India [14]. Other reports also showed mixed infection with three pathogens from India [15]. The present study describes such case of mixed infection with three pathogens transmitted by mosquitoes from New Delhi, India during monsoon season 2016.…”
Arthropod-borne infections like malaria, dengue and chikungunya fever are transmitted by mosquitoes. The present report describes an unusual case of mixed infection with malaria, dengue and chikungunya viruses in a 21 year old male patient from New Delhi, India during monsoon season of 2016. The malarial fever was diagnosed by thin slide microscopy and antigen test. Chikungunya virus IgM was detected in the sample by the card test. Dengue and chikungunya viruses were further confirmed by RT-PCR for CprM and E1 gene respectively. Phylogenetic analysis clustered the study dengue virus serotype 3 sequence in the genotype III. Thus, the mono infections can not be differentiated from concurrent infections on the basis of clinical symptoms, the appropriate laboratory diagnosis is essential for the accurate pathogen confirmation. Precise and appropriate identification of the multiple pathogens in such clinical cases will assist in the effective management of these arthropod mediated infections.
“…An investigation reported concurrent infection with Plasmodium, DENV and CHIKV in a traveler from India [14]. Other reports also showed mixed infection with three pathogens from India [15]. The present study describes such case of mixed infection with three pathogens transmitted by mosquitoes from New Delhi, India during monsoon season 2016.…”
Arthropod-borne infections like malaria, dengue and chikungunya fever are transmitted by mosquitoes. The present report describes an unusual case of mixed infection with malaria, dengue and chikungunya viruses in a 21 year old male patient from New Delhi, India during monsoon season of 2016. The malarial fever was diagnosed by thin slide microscopy and antigen test. Chikungunya virus IgM was detected in the sample by the card test. Dengue and chikungunya viruses were further confirmed by RT-PCR for CprM and E1 gene respectively. Phylogenetic analysis clustered the study dengue virus serotype 3 sequence in the genotype III. Thus, the mono infections can not be differentiated from concurrent infections on the basis of clinical symptoms, the appropriate laboratory diagnosis is essential for the accurate pathogen confirmation. Precise and appropriate identification of the multiple pathogens in such clinical cases will assist in the effective management of these arthropod mediated infections.
“…1). Two samples showed concurrent infection by three arthropod mediated pathogens, namely, DENV-3, CHIKV and Plasmodium vivax [27, 28]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…References/sources for these reports are given in Supplementary Table S2 and S3. Another interesting aspect of the investigation was concurrent infection with three different arthropod mediated pathogens (DENV, CHIKV and Plasmodium vivax ) in two patients [27, 28]. Such cases of infection with multiple pathogens pose a challenge for the diagnosis of the aetiological agents due to the overlapping clinical spectrum of the three diseases.…”
Co-circulation of Chikungunya and Dengue viral infections (CHIKV and DENV) have been reported mainly due to transmission by common Aedes vector. The purpose of the study was to identify and characterise the circulating strains of CHIKV and DENV in DENV endemic region of New Delhi during 2016. CHIKV and DENV were identified in the blood samples (n = 130) collected from suspected patients by RT-PCR. CHIKV was identified in 26 of 65 samples (40%). Similarly, DENV was detected in 48 of 120 samples (40%). Co-infection with both the viruses was identified in five (9%) of the samples. Interestingly, concurrent infection with DENV, CHIKV and Plasmodium vivax was detected in two samples. CHIKV strains (n = 11) belonged to the ECSA genotype whereas DENV-3 sequences (n = eight) clustered in Genotype III by phylogenetic analysis. Selection pressure of E1 protein of CHIKV and CprM protein of DENV-3 revealed purifying selection with four and two positive sites, respectively. Four amino acids of the CHIKV were positively selected and had high entropy suggesting probable variations. Co-circulation of both viruses in DENV endemic regions warrants effective monitoring of these emerging pathogens via comprehensive surveillance for implementation of effective control measures.
“…A number of epidemiological studies have reported co‐infections of CHIKV with pathogens such as Zika virus (ZIKV), dengue virus (DENV), and malaria parasites in humans although the pathological outcomes of these co‐infections have not been clearly defined. Particularly, different clinical reports from African malaria cohorts suggested the presence of CHIKV infections. Furthermore, the highly pro‐inflammatory profiles of both diseases—including the detrimental contribution of T cell‐mediated immune responses to the pathologies—and the immunosuppressive nature of malaria infections speculate that immune modulation might occur.…”
Section: Co‐infection With Plasmodium Parasites Modulates Chikv Pathomentioning
The induction of polyarthritis and polyarthralgia is a hallmark of arthritogenic alphavirus infections, with an exceptionally higher morbidity observed with chikungunya virus (CHIKV). While the mechanisms underlying these incapacitating acute symptoms remain partially understood, the progression to chronic conditions in some cases remains unanswered. The highly pro‐inflammatory nature of alphavirus disease has suggested the involvement of virus‐specific, joint‐infiltrating Th1 cells as one of the main pathogenic mediators of CHIKV‐induced joint pathologies. This review summarizes the role of cell‐mediated immune responses in CHIKV pathogenesis, with a specific focus on pro‐inflammatory Th1 responses in the development of CHIKV joint inflammation. Furthermore, due to the explosive nature of arthritogenic alphavirus outbreaks and their recent expansion across the world, co‐infections with other highly prevalent pathogens such as malaria are likely to occur but the pathological outcomes of such interactions in humans are unknown. This review will also discuss the potential impact of malaria co‐infections on CHIKV pathogenesis and their relevance in alphavirus control programs in endemic areas.
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