Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua

Abstract

BackgroundDengue is an emerging infectious disease of global significance. Suspected dengue, especially in children in Nicaragua’s heavily-urbanized capital of Managua, has been well documented, but unsuspected dengue among children and adults with undifferentitated fever has not.Methodology/Principal FindingsTo prospectively study dengue in semi-urban and rural western Nicaragua, we obtained epidemiologic and clinical data as well as acute and convalescent sera (2 to 4 weeks after onset of illness) from a convenience sample (enrollment Monday to Saturday daytime to early evening) of consecutively enrolled patients (n = 740) aged ≥ 1 years presenting with acute febrile illness. We tested paired sera for dengue IgG and IgM and serotyped dengue virus using reverse transcriptase-PCR. Among 740 febrile patients enrolled, 90% had paired sera. We found 470 (63.5%) were seropositive for dengue at enrollment. The dengue seroprevalance increased with age and reached >90% in people over the age of 20 years. We identified acute dengue (serotypes 1 and 2) in 38 (5.1%) patients. Only 8.1% (3/37) of confirmed cases were suspected clinically.Conclusions/SignificanceDengue is an important and largely unrecognized cause of fever in rural western Nicaragua. Since Zika virus is transmitted by the same vector and has been associated with severe congenital infections, the population we studied is at particular risk for being devastated by the Zika epidemic that has now reached Central America.

Zoonotic and vector borne agents causing disease in adult patients hospitalized due to fever of unknown origin in Thailand

“…From Table 1, dengue fever and scrub typhus were the major causes of patient hospitalized FUO. The results were similar to other studies that found dengue was responsible for febrile illnesses in sub-Saharan Africa and other countries [8][9][10]. A study in Rajasthan, India [11] presented 49.1% of patients with FUO that were confirmed by scrub typhus immunoglobulin M antibodies by ELISA and had a similar result to another prospective study among patients with FUO in Chennai City, South India [12], presenting 23% of patients positive for immunoglobulin M antibodies against Orientia tsutsugamushi.…”

The introduction of dengue follows transportation infrastructure changes in the state of Acre, Brazil: A network-based analysis

“…aegypti was found in rural regions [ 65 ] south of Bogotá. In Nicaragua, a study showed the unsuspected presence of dengue cases in those areas as well [ 66 ].…”

Serologic surveillance of maternal Zika infection in a prospective cohort in Leon, Nicaragua during the peak of the Zika epidemic

“…Of 187 women, 176 (94%) were ZIKV IgG ELISA positive (Table 2), consistent with high DENV prevalence and poor specificity of ELISA. [26] Using a combination of ELISA and neutralization testing ("Integrated Result"), the overall ZIKV seroprevalence at the time of delivery in this population was estimated to be 59% (Table 2). To validate our method for determining ZIKV seroprevalence, 85 delivery specimens were blindly tested at an independent laboratory using ZIKV NS1 BOB.…”