A cross sectional study of dengue virus infection in febrile patients presumptively diagnosed of malaria in Maiduguri and Jos plateau, Nigeria

Abstract

BackgroundIn Nigeria, where malaria is endemic, greater than 70% of febrile illnesses are treated presumptively as malaria, often without a laboratory evaluation for other possible causes of fever. This cross-sectional study evaluated the presence of dengue virus infection in febrile patients, presumptively diagnosed of malaria infections in the clinic.MethodologyBlood samples were collected from 529 febrile patients (246 in Jos and 283 in Maiduguri) attending the general outpatient clinics of the Jos University Teaching Hospital (JUTH) and the University of Maiduguri Teaching Hospital (UMTH) and tested for anti-dengue immunoglobulin M (IgM) and immunoglobulin G (IgG), as well as anti-non-structural protein (NS1) by ELISA. The samples were also evaluated for presence of P. falciparum malaria parasites by microscopic examination of Giemsa-stained blood smears.ResultsThe prevalence of confirmed, highly suggestive and probable dengue virus infections categorized in relation to duration of illness since onset of fever were 2.3%, 5.5% and 1.5% respectively, while the prevalence of anti-flavivirus IgG and IgM seropositivity was 11.7%. In a total of 117 (22.1%) patients (32 in Jos, 85 in Maiduguri), malaria parasites were detected by blood smear microscopy, out of which 7 (6%) also had a positively confirmed, highly suggestive or probable dengue test result.ConclusionAlthough the high cross-reactivity of anti-flavivirus antibodies should be taken into account in the interpretation of the seroprevalence data, our findings suggest a significant presence of dengue virus in this environment, some of which may otherwise be misdiagnosed as malaria. These findings are strong enough to recommend serological screening for anti-dengue virus titer and NS1 antigen for all febrile patients, as part of fever diagnostic protocols in tropical regions. Given the prevalence of dengue virus infections, there is also a need for a dengue control program and public education to prevent outbreaks and occurrence of severe dengue complications.

Dengue Virus Infection and Associated Risk Factors in Africa: A Systematic Review and Meta-Analysis

“…The findings from previous studies [ 90 , 91 ] show that co-morbidities increase the risk of severe disease and fatal outcomes among dengue patients. Our results show that in the past decade (2010–2020), malaria and dengue co-infections were the most prevalent, followed by dengue and chikungunya co-infection [ 24 , 31 , 40 , 43 , 53 , 56 , 79 , 92 , 93 , 94 , 95 ]. A similar occurrence pattern of malaria and dengue co-infection dominance followed by dengue and chikungunya co-infection was previously reported [ 96 ].…”

Dengue Virus is Hyperendemic in Nigeria from 2009 to 2020: A Contemporary Systematic Review

“…1 ). The studies were 21 eligible studies conducted from 2009 to 2020 [ 8 11 15 16 17 18 19 20 21 23 24 25 26 27 28 29 30 31 ]. Three out of the 21 studies reported co-circulation of all the 4 serotypes, while 2 studies separately reported co-circulation of DENV-1 & 2 and DENV-1 to 3 ( Table 1 ).…”

Detection of IgM and IgG Dengue antibodies in febrile patients suspected of malaria attending health center in Jos, Nigeria

“…Our findings showed high dengue prevalence in the study population. Several dengue seroprevalence studies have been carried out within the Jos area (Kingsley et al;Dawurung et al, 2010;Onyedibe, 2018), that also detected different dengue prevalence rates in the population and other parts of Nigeria (Adesina and Adeniji, 2016;Bello et al, 2016;Kolawole et al, 2017). The high prevalence recorded, could be due to the fact that this study coincided with the warm temperatures and rainy season (April -October) in this region, a suitable condition for the breeding of mosquito that transmits the virus.…”