Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study

Abstract

BackgroundPathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis.MethodologyWe conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections.ResultsInvestigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue–caused by DENV-1 and/or DENV-2 –and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment.DiscussionChikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will–ultimately and hopefully–improve the clinical care of outpatients in low-resource settings.Trial registrationClinicalTrials.gov NCT02656862.

Dengue in western Uganda: A prospective cohort of children presenting with undifferentiated febrile illness

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Seroprevalence, spatial dispersion and factors associated with flavivirus and chikungunya infection in a risk area: a population-based seroprevalence study in Brazil

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Important Aedes Spp. Density Levels in Kinshasa, Democratic Republic of Congo

“…In a place like Kinshasa, where dengue is rarely reported [21][22][23][24] and chikungunya and yellow fever cause sporadic outbreaks [16,18,41], we didn't expect to nd such high Aedes densities. The observed densities are comparable to the ones of other African settings: south-eastern Tanzania has a HI of 4.9 -6.6, CI of 14.6-18.9 [42]; Burkina Faso a HI of 70, CI of 35 and BI of 10 [43]; north-west Ethiopia a HI of 25.5, CI of 32.9 and BI of 48.4 [44]; Mozambique a CI of 22 [45]; and Angola a HI of 4.3 -27.9, CI of 2.1-9.3 and BI of 5.8-42.2 [46].…”