Diagnostic challenges of arboviral infections and dengue virus serotype distribution in febrile patients in East Java, Indonesia

Abstract

Objectives: Arboviruses pose significant public health threats worldwide, with Southeast Asia being a hotspot for these infections. This study aimed to reassess the incidence of dengue, Zika, and chikungunya viruses in patients clinically diagnosed with dengue in East Java, Indonesia in 2023.

Methods: The study included 108 patients admitted to hospitals in Jember, with blood samples collected on admission. Multiplex reverse transcription-polymerase chain reaction was used to detect viral RNA for dengue, Zika, and chikungunya, whereas dengue serotypes were identified using real-time polymerase chain reaction.

Results: A total of 67 of 108 (62%) patients tested positive for dengue virus (DENV), one patient tested positive for chikungunya, and no cases of Zika were detected. Differences in laboratory parameters between patients who were DENV RNA-negative and confirmed dengue cases suggest possible misdiagnosis of dengue. Serotyping of DENV-positive samples revealed DENV serotype 3 as the predominant serotype in Jember, accounting for 34% of cases (n = 23 of 67), followed by DENV serotype 1 and DENV serotype 2 at 19% each (n = 13 of 67) and 6% for DENV-4 (n = 4 of 67), whereas 21% (n = 14 of 67) remained untyped.

Conclusions: This study highlights the nature of the dengue outbreak in Jember in 2023, where all four DENV serotypes were in circulation, and underlines the need for serological or nucleic acid-based methods to improve arbovirus diagnosis in the region.

Keywords: Arboviruses; Chikungunya; Dengue; Indonesia; Serotypes; Zika.