Coinfection With Zika and Dengue-2 Viruses in a Traveler Returning From Haiti, 2016: Clinical Presentation and Genetic Analysis

Abstract

Zika virus and dengue virus serotype 2 were isolated from a patient with travel to Haiti who developed fever, rash, arthralgias, and conjunctivitis. The infecting Zika virus was related to Venezuelan and Brazilian strains but evolved along a lineage originating from strains isolated in 2014 in the same region of Haiti.

Keywords: Haiti; Zika virus; dengue virus.

Figure 1.

Timeline, physical manifestations, and test results of patient with dual dengue virus serotype 2/Zika virus infection. A, Timeline of travel, physical manifestations, and test results. B, Fine, erythematous rash on neck and upper chest on day 2 after initial symptom onset. C, Rash on thigh, also day 2. D, Resolving conjunctivitis on day 8 after symptom onset.

Figure 2.

Phylogenetic and phylogeography analyses of Zika virus (ZIKV) strains. A, Maximum-likelihood tree of ZIKV complete genome sequences. Branches are drawn to scale in nucleotide substitutions per site according to the bar at the bottom of the tree. *Indicates bootstrap support (>90%) or significant Shimodaira-Hasegawa-like probability (P < .01). **Indicates significant support in both tests. The 2016 Haiti sequence (ZIKV Haiti/1/2016) is in bold. Highlighted in yellow is the clade containing ZIKV Haiti/1/2016, the only other fully sequenced Haitian strain from 2014 (KU509998), a Brazilian strain from 2015 (KU321639), and a Venezuelan strain from 2016 (KU744693). B, Maximum clade credibility tree with Bayesian phylogeography reconstruction of the ZIKV NS5 gene region. Branches are scaled in time and colored according to the legend to the left where each color represents the geographic location of the sampled sequence (tip branches), as well as of the ancestral lineage (internal branches) inferred by Bayesian phylogeography. The molecular clock was calibrated by using ZIKV strains’ known sampling times and enforcing a relaxed molecular clock with a Bayesian skyline plot demographic prior (see Supplementary Methods). Posterior probabilities >0.5 are indicated along the branches. The 2016 Haitian sequence is in bold. Proposed migration events involving the Haitian strains are indicated by arrows: The red arrow indicates viral gene flow from Easter Island to Haiti; the green arrow indicates viral gene flow from Haiti back to Easter Island, and the orange arrow indicates viral gene flow from Haiti to Venezuela.