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. 2018 Jan 30;18(1):61.
doi: 10.1186/s12879-018-2976-1.

Co-circulation and simultaneous co-infection of dengue, chikungunya, and zika viruses in patients with febrile syndrome at the Colombian-Venezuelan border

Marlen Yelitza Carrillo-Hernández  1   2   3   4 , Julian Ruiz-Saenz  1 , Lucy Jaimes Villamizar  5 , Sergio Yebrail Gómez-Rangel  2 , Marlen Martínez-Gutierrez  6
Affiliations

Co-circulation and simultaneous co-infection of dengue, chikungunya, and zika viruses in patients with febrile syndrome at the Colombian-Venezuelan border

Marlen Yelitza Carrillo-Hernández et al. BMC Infect Dis. .

Abstract

Background: In Colombia, the dengue virus (DENV) has been endemic for decades, and with the recent entry of the chikungunya virus (CHIKV) (2014) and the Zika virus (ZIKV) (2015), health systems are overloaded because the diagnosis of these three diseases is based on clinical symptoms, and the three diseases share a symptomatology of febrile syndrome. Thus, the objective of this study was to use molecular methods to identify their co-circulation as well as the prevalence of co-infections, in a cohort of patients at the Colombian-Venezuelan border.

Methods: A total of 157 serum samples from patients with febrile syndrome consistent with DENV were collected after informed consent and processed for the identification of DENV (conventional PCR and real-time PCR), CHIKV (conventional PCR), and ZIKV (real-time PCR). DENV-positive samples were serotyped, and some of those positive for DENV and CHIKV were sequenced.

Results: Eighty-two patients were positive for one or more viruses: 33 (21.02%) for DENV, 47 (29.94%) for CHIKV, and 29 (18.47%) for ZIKV. The mean age range of the infected population was statistically higher in the patients infected with ZIKV (29.72 years) than in those infected with DENV or CHIKV (21.09 years). Both co-circulation and co-infection of these three viruses was found. The prevalence of DENV/CHIKV, DENV/ZIKV, and CHIKV/ZIKV co-infection was 7.64%, 6.37%, and 5.10%, with attack rates of 14.90, 12.42, and 9.93 cases per 100,000 inhabitants, respectively. Furthermore, three patients were found to be co-infected with all three viruses (prevalence of 1.91%), with an attack rate of 4.96 cases per 100,000 inhabitants.

Conclusion: Our results demonstrate the simultaneous co-circulation of DENV, CHIKV, ZIKV and their co-infections at the Colombian-Venezuelan border. Moreover, it is necessary to improve the differential diagnosis in patients with acute febrile syndrome and to study the possible consequences of this epidemiological overview of the clinical outcomes of these diseases in endemic regions.

Keywords: Chikungunya virus; Co-circulation; Co-infection; Dengue virus; Zika virus.

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Conflict of interest statement

Ethics approval and consent to participate

The Research and Ethics Committees of the Universidad Cooperativa de Colombia (Act from meeting April 16th of 2015) and by the technical committee of the E.S.E. Jorge Cristo Sahium Hospital (Rad # 087, July 28th, 2015) approved this study. Informed written consent was obtained from the parents or legal guardian of the patient before inclusion in the study. All persons 18 years and older signed the agreement or informed consent. In the case of children under 18 years old, the informed written consent was obtained from their parent or legal guardian.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Geographical location of the sampling site in Colombia. The pink area denotes Norte de Santander Province, and the blue area denotes Villa del Rosario City. The map was created using DIVA-GIS software version 7.5.0 for Windows™. See text for references
Fig. 2
Fig. 2
Temporal distribution of infection by DENV, CHIKV, and ZIKV. In general, the largest number of cases (70.7%) were reported between December 2015 and February 2016
See this image and copyright information in PMC

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