Co-circulation and simultaneous co-infection of dengue, chikungunya, and zika viruses in patients with febrile syndrome at the Colombian-Venezuelan border

Abstract

BackgroundIn Colombia, the dengue virus (DENV) has been endemic for decades, and with the recent entry of the chikungunya virus (CHIKV) (2014) and the Zika virus (ZIKV) (2015), health systems are overloaded because the diagnosis of these three diseases is based on clinical symptoms, and the three diseases share a symptomatology of febrile syndrome. Thus, the objective of this study was to use molecular methods to identify their co-circulation as well as the prevalence of co-infections, in a cohort of patients at the Colombian-Venezuelan border.MethodsA total of 157 serum samples from patients with febrile syndrome consistent with DENV were collected after informed consent and processed for the identification of DENV (conventional PCR and real-time PCR), CHIKV (conventional PCR), and ZIKV (real-time PCR). DENV-positive samples were serotyped, and some of those positive for DENV and CHIKV were sequenced.ResultsEighty-two patients were positive for one or more viruses: 33 (21.02%) for DENV, 47 (29.94%) for CHIKV, and 29 (18.47%) for ZIKV. The mean age range of the infected population was statistically higher in the patients infected with ZIKV (29.72 years) than in those infected with DENV or CHIKV (21.09 years). Both co-circulation and co-infection of these three viruses was found. The prevalence of DENV/CHIKV, DENV/ZIKV, and CHIKV/ZIKV co-infection was 7.64%, 6.37%, and 5.10%, with attack rates of 14.90, 12.42, and 9.93 cases per 100,000 inhabitants, respectively. Furthermore, three patients were found to be co-infected with all three viruses (prevalence of 1.91%), with an attack rate of 4.96 cases per 100,000 inhabitants.ConclusionOur results demonstrate the simultaneous co-circulation of DENV, CHIKV, ZIKV and their co-infections at the Colombian-Venezuelan border. Moreover, it is necessary to improve the differential diagnosis in patients with acute febrile syndrome and to study the possible consequences of this epidemiological overview of the clinical outcomes of these diseases in endemic regions.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-2976-1) contains supplementary material, which is available to authorized users.

Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia

“…In which case it is also possible to consider that dengue's force of infection could influence its predominance in Latin America . However, given the nature of these studies, these findings are influenced by individual immunological status and a health seeking behaviour that has not been widely studied in our context , and therefore should be interpreted with caution.…”

Clinical and Epidemiologic Patterns of Chikungunya Virus Infection and Coincident Arboviral Disease in a School Cohort in Haiti, 2014–2015

“…It is clear from our study, and other longitudinal studies [7,26], that as the epidemic moved through islands and countries it was the dominant cause of AFI for a period of 2-4 months. However, in both longitudinal and cross-sectional studies [7,26,27], what also emerges is a more complex picture of a mélange of arboviral infections, with frequent coinfections and cases and case clusters attributable to other viruses surrounding the CHIKV epidemic peak. In Haiti, in contrast to other studies that relied on serologic assays, we performed actual viral cultures on a majority of case patients; findings further underscored the extent of coinfections [19], and resulted in the identification of "unexpected" viruses, such as ZIKV and MAYV.…”

A scoping review of Chikungunya virus infection: epidemiology, clinical characteristics, viral co-circulation complications, and control

“…Significantly, Ae. aegypti can also be the main vector of other viruses, such as ZIKV and DENV, and co-transmission events may be observed (Carrillo-Hernández et al, 2018). However, it has been demonstrated that simultaneous infections by DENV/CHIKV/ZIKV or DENV/CHIKV in Ae.…”

“…In addition, it is difficult to determine the frequency and intensity of the symptoms and correctly assess pain (mild, moderate and intense) of afflicted patients (Table 1). In this context, variations in the clinical presentation of cases can give hints as to the viral etiology; for instance, the salient and prolonged polyarthralgia, often accompanied by rash, is typically more indicative of chikungunya, while hemorrhagic manifestations and myalgia are more commonly observed in DENV infections (Lee et al, 2012) Despite the patients co-infected with CHIKV/DENV, CHIKV/ZIKV and CHIKV/DENV/ZIKV often do not show exacerbation of clinical signs, the co-infection presents as additional obstacle during differential diagnosis (Furuya-Kanamori et al, 2016;Villamil-Gómez et al, 2016;Carrillo-Hernández et al, 2018). Tables 1 and 2 summarize clinical and laboratory features that should be evaluated for efficient differential diagnosis of CHIKV, DENV and ZIKV infections.…”