Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay

Abstract

Background In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. Methods Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). Results A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0–0.3). Conclusions Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.

Successful management of dengue in renal transplant recipients: A retrospective cohort from a single center

“…These findings are similar to our report, where all of the malarial cases had anemia and splenomegaly on admission. Rojas A et al 23 found headache, red eyes, leucopenia, and thrombopenia commoner in dengue compared to other febrile illnesses similar to our study. There have been recent efforts to develop testing kits for simultaneous detection of viral infections that are in close differentials from each other 24,25 …”

Características clínicas y de laboratorio en pacientes pediátricos ambulatorios con Fiebre Dengue

“…El DENV corresponde al género Flavivirus de la familia Flaviviridae, con cuatro serotipos filogenética y antigénicamente distintos (DENV-1, DENV-2, (2,3) DENV-3 y DENV-4) . La infección por DENV tiene un amplio espectro de presentaciones clínicas pudiendo causar desde infección subclínica a formas graves con choque y complicaciones (4) (hemorragias, hepatitis, miocarditis, encefalitis) .…”

Dengue Virus and Yellow Fever Virus Detection Using Reverse Transcription–Insulated Isothermal PCR and Comparison with Real-Time RT-PCR

“…4 Rapid diagnostics are available for the detection of DENV nonstructural protein 1 (NS1) and anti-DENV IgM, but these are significantly less sensitive than rRT-PCR during acute infection. 6,7 Testing for anti-YFV IgM is often limited to reference laboratories. For both DENV and YFV, IgM is not reliably detectable until 5 days after symptom onset, and significant cross-reactivity occurs between flaviviruses.…”

“…14,15,17 The POCKIT DENV assay demonstrated a sensitivity of 87.2% and detected 96.2% of DENVpositive samples with viral loads ³ 4.0 log 10 copies/mL. Viral loads in this range are common among patients who present within the first 5 days of symptom onset, 7 such that assay use could be targeted to a high-yield population based on information that is readily available at presentation. Notably, sensitivity is higher than that of a rapid NS1 assay used to test patients in Paraguay (71.4%).…”

“…Notably, sensitivity is higher than that of a rapid NS1 assay used to test patients in Paraguay (71.4%). 7 Given the rapidity of assay performance (setup time, ∼5-10 minutes; run time, 45 minutes), this could provide a sensitive testing option for use near the point of patient care.…”