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. 2016 Oct 28;10(10):e0005026.
doi: 10.1371/journal.pntd.0005026. eCollection 2016 Oct.

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

Megan E Reller  1   2 , Aravinda M de Silva  3 , Jeremy J Miles  4 , Ramesh S Jadi  3 , Anne Broadwater  3 , Katie Walker  3 , Christopher Woods  2   5 , Orlando Mayorga  6 , Armando Matute  6
Affiliations

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

Megan E Reller et al. PLoS Negl Trop Dis. .

Abstract

Background: Dengue 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 findings: To 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/significance: Dengue 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Temporal distribution of cases of acute dengue versus other febrile illness, Nicaragua.
Fig 2
Fig 2. Age distribution of patients with acute dengue versus other febrile illness, Nicaragua.
Fig 3
Fig 3. Proportion (%) of febrile patients with IgG against dengue, by age, Nicaragua.
See this image and copyright information in PMC

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