Chikungunya Virus Infections Among Patients with Dengue-Like Illness at a Tertiary Care Hospital in the Philippines, 2012–2013

Abstract

Abstract. Chikungunya virus (CHIKV) often co-circulates with dengue virus (DENV). A cross-sectional surveillance study was conducted at a tertiary hospital in Manila, Philippines, to describe the prevalence and characteristics of DENV and CHIKV infections among patients seeking care for dengue-like illness. Acute blood samples from patients ≥ 6 months of age clinically diagnosed with dengue from November 2012 to December 2013 underwent reverse transcription polymerase chain reaction (RT-PCR) to detect DENV and CHIKV RNA. A total of 118 patients with clinically diagnosed dengue (age range = 1-89 years, mean = 22 years; male-to-female ratio = 1.51) were tested by DENV RT-PCR; 40 (34%) were DENV PCR-positive (age range = 1-45 years, mean = 17 years). All DENV serotypes were detected: 11 (28%) DENV-1, 6 (15%) DENV-2, 6 (15%) DENV-3, and 17 (42%) DENV-4. Of 112 patients clinically diagnosed with dengue and tested by CHIKV RT-PCR, 11 (10%) were CHIKV PCR-positive (age range = 2-47 years, mean = 20.3 years). No coinfections were detected. Presenting signs/symptoms did not differ between DENV-and CHIKV-positive cases. Sequencing of envelope 1 gene from two CHIKV PCR-positive samples showed Asian genotype. This study highlights the potential for misdiagnosis of medically attended CHIKV infections as DENV infection and the difficulty in clinically differentiating dengue and chikungunya based on presenting signs/symptoms alone. This underscores the necessity for diagnostic laboratory tests to distinguish CHIKV infections in the background of actively co-circulating DENV.

Co-infección por los virus del dengue y chikungunya. Revisión narrativa

“…En Yemen, en el año 2012, un estudio reportó co-infección de 2,3% 35 . Para el período 2012 y 2013, en Filipinas se identificó la co-infección en 11 casos (10%) a partir de 112 pacientes con diagnóstico de dengue por reacción de polimerasa en cadena (RPC) 36 . En Nepal, para los mismos años, se analizaron 169 muestras de todos los pacientes febriles al ingreso de varios hospitales y se halló la co-infección en cinco casos (5,0%) 37 .…”

“…Siete estudios no exponen con claridad el cuadro clínico de los pacientes con co-infección en comparación con los pacientes con mono-infección por DENV o CHIKV 26,34,[36][37]39,41,53 . Dos artículos en La India y uno en Guatemala presentan con mayor precisión el cuadro clínico de los pacientes co-infectados.…”

“…En La India, para el 2011 se reportó circulación de DENV-1, DENV-2 y DENV-3, al igual que el genotipo ECSA del CHIKV 69 . En Filipinas, para el período 2012-2013, a través de RPC para CHIKV, se determinó la presencia del genotipo asiático 36 , similar a lo reportado en viajeros provenientes de las Américas 19 . En Gabón, África, en el 2007 fue encontrado el ECSA, posterior-mente el genotipo asiático y en el 2010 el genotipo de África occidental 1, 31 .…”

The Interplay of Viral and Host Factors in Chikungunya Virus Infection: Targets for Antiviral Strategies

“…According to historical records, CHIKV is likely to have been present since 1779 [10]. However, due to the similar clinical manifestations between CHIKV and dengue infections, CHIKV-infected patients were likely to have been initially misdiagnosed as having dengue infection [10,11]. CHIKV was first isolated and identified during an outbreak in Tanzania in 1953 [4].…”

Comparison of morbidity and mortality between serologically positive and serologically negative dengue cases

“…14 Velasco JM et al found many Chikungunya Virus among Patients with Dengue-Like Illness. 15 This emphasizes the need for a routine and differential diagnosis of arboviruses in patients with dengue-like illness. Unfortunately, laboratory assays, such as real-time reverse transcription polymerase chain reaction, virus cDNA sequencing, and enzyme-linked immunosorbent assay are not easily available.…”