Dengue in Bali: Clinical characteristics and genetic diversity of circulating dengue viruses

Abstract

A high number of dengue cases are reported annually in Bali. Despite the endemicity, limited data on dengue is available for Bali localities. Molecular surveillance study was conducted to explore the clinical and virological characteristics of dengue patients in urban Denpasar and rural Gianyar areas in Bali during the peak season in 2015. A total of 205 adult dengue-suspected patients were recruited in a prospective cross-sectional study. Demographic and clinical information were obtained, and dengue screening was performed using NS1 and IgM/IgG ELISAs. Viral RNA was subsequently extracted from patients’ sera for serotyping using conventional RT-PCR and Simplexa Dengue real-time RT-PCR, followed by genotyping with sequencing method. We confirmed 161 patients as having dengue by NS1 and RT-PCR. Among 154 samples successfully serotyped, the DENV-3 was predominant, followed by DENV-1, DENV-2, and DENV-4. Serotype predominance was different between Denpasar and Gianyar. Genotyping results classify DENV-1 isolates into Genotype I and DENV-2 as Cosmopolitan Genotype. The classification grouped isolates into Genotype I and II for DENV-3 and DENV-4, respectively. Clinical parameters showed no relationship between infecting serotypes and severity. We observed the genetic diversity of circulating DENV isolates and their relatedness with historical data and importation to other countries. Our data highlights the role of this tourist destination as a potential source of dengue transmission in the region.

Tumour necrosis factor-alpha level among travellers contracted with dengue virus in Bali

“…The most predominant serotype detected was DENV-3. This finding is similar with the result from local Balinese in 2015 where DENV-3 was predominant [17]. Our result was in contrast with data reported by Ernst, et al [21].…”

“…The intensive labor flow and travelers factors in Bali have been reported to contribute to the spread of DENV infection [20]. Previous reports indicated the hyperendemic transmission of all four DENV serotypes in Bali where circulating DENVs included dominant local strains, suggesting that Bali is a melting pot of substantial DENV diversity and serve as a hub for dengue transmission and mixing [17], [21].…”

“…Bali has become the most popular tourism destination in the world. Dengue infection has been found hyperendemic in Bali since all four DENV serotype circulate in Bali [17]. Travellers visiting Bali are at risk to get DENV infection during visiting Bali.…”

Dengue diagnosis in an endemic area of Peru: Clinical characteristics and positive frequencies by RT-PCR and serology for NS1, IgM, and IgG

“…All four serotypes are capable of causing an infection that induces a primary immune response, leading to long-term protection against only the homologous serotype. However, if a secondary infection with a different serotype occurs, the immune response can lead to a more severe dengue fever presentation in some cases (Megawati et al, 2017). The incubation period ranges from 3 to 14 days and symptoms usually develop between 4 and 7 days after the vector bite (Fukusumi et al, 2016).…”

MCP-1 LEVELS AND ATYPICAL LYMPHOCYTES IN EARLY FEVER OF DENGUE VIRUS INFECTION WITH NON-STRUCTURAL PROTEIN 1 (NS-1) ANTIGEN TEST IN dr DARSONO HOSPITAL, PACITAN

“…10 The secondary infection with a different serotype occurs, the immune response can lead to the presentation of dengue fever is more severe in some cases. 32 The incubation period ranges from 3 to 14 days and symptoms usually develop between 4 and 7 days after vector bites. 33 Dengue infection is usually confirmed by viral genomic RNA identification, antigen, or the antibodies it causes.…”