Unidentified dengue serotypes in DENV positive samples and detection of other pathogens responsible for an acute febrile illness outbreak 2016 in Cajamarca, Peru

Abstract

Objective To describe the prevalence of dengue virus serotypes, as well as other viral and bacterial pathogens that cause acute febrile illness during an outbreak in Cajamarca in 2016. Results Dengue virus (DENV) was the most frequent etiologic agent detected in 25.8% of samples (32/124), followed by Rickettsia spp. in 8.1% (10/124), Zika virus in 4.8% (6/124), Chikungunya virus 2.4% (3/124) and Bartonella bacilliformis 1.6% (2/124) cases. No positive cases were detected of Oropouche virus and Leptospira spp. DENV serotypes identification was only achieved in 23% of the total positive for DENV, two samples for DENV-2 and four samples for DENV-4. During the 2016 outbreak in Cajamarca—Peru, it was observed that in a large percentage of positive samples for DENV, the infecting serotype could not be determined by conventional detection assays. This represents a problem for the national surveillance system and for public health due to its epidemiological and clinical implications. Other viral and bacterial pathogens responsible for acute febrile syndrome were less frequently identified.

Oropouche virus infection in patients with acute febrile syndrome: Is a predictive model based solely on signs and symptoms useful?

“…This is because the symptoms of the patient with Oropouche fever were very similar to those of other arboviral diseases and not specific to Oropouche infection [ 5 ]. This does not help with the prediction or diagnosis of OROV disease [ 3 ], especially in endemic areas of coinfection of these diseases [ 5 , 27 ]. The findings of this study are similar to other studies that described the typical clinical manifestations such as fever, headache, myalgia, arthralgia.…”

“…In the same way, the variable odynophagia was the only one that was positively associated with the clinical diagnosis of OROV using the CPR. Therefore, symptomatology is probably not useful to build a clinical prediction model, especially in a country like Peru, in which there is a high prevalence of arboviral diseases that end up overlapping because they are differential diagnoses [ 27 , 28 ]. These findings are consistent with other studies where it was found that the etiological clinical diagnosis of OROV infection was not possible due to the low specificity of the symptoms, which is why molecular diagnosis is recommended [ 15 , 27 , 28 ].…”

“…At the epidemiological level, the Peruvian National System has not proposed any detection strategy for the laboratory diagnosis of the OROV virus [ 25 ]. In primary care centers, it is a challenge for physicians to differentiate OROV fever from other diseases that are circulating in endemic areas, especially DENV, ZIKV and CHIKV.Therefore it is recommended that the differential clinical diagnosis be based on specific laboratory tests that confirm OROV infection [ 27 ]. This will improve decision making in cases of clinical uncertainty and improve the diagnostic, therapeutic, or prognostic precision of arbovirus infections [ 29 ].…”

“…Previous research indicated that it is relevant to include the clinical and laboratory diagnosis of OROV in epidemiological surveillance [ 30 ]. Especially in Peru, to propose the best mitigation strategies for these diseases, and to appropriately allocate public health resources for the use of sophisticated and highly efficient laboratory tests [ 17 , 27 ]. Therefore, to have a highly efficient detection of OROV, it is essential to invest in the equipment required for the molecular diagnosis of OROV and to train the professionals who will carry out the tests [ 28 ].…”

The Chikungunya virus: A reemerging cause of acute febrile illness in the high jungle of northern Peru

“…This province is located at a mean altitude of 729 masl and has warm tropical weather with an annual mean temperature of 24.2°C. Several pathogens responsible for AFI have been reported in this region, which include DENV, Oropouche virus (OROV), ZIKV, leptospirosis, bartonelosis, rickettsia, and malaria, among others [ 8 , 9 , 14 ].…”