Abstract

BackgroundDengue is a vector-borne disease in the tropical and subtropical region of the world and is transmitted by the mosquito Aedes aegypti. In the state of Amazonas, Brazil during the 2011 outbreak of dengue all the four Dengue virus (DENV) serotypes circulating simultaneously were observed. The aim of the study was to describe the clinical epidemiology of dengue in Manaus, the capital city of the state of the Amazonas, where all the four DENV serotypes were co-circulating simultaneously.MethodologyPatients with acute febrile illness during the 2011 outbreak of dengue, enrolled at the Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), a referral centre for tropical and infectious diseases in Manaus, were invited to participate in a clinical and virological descriptive study. Sera from 677 patients were analyzed by RT-nested-PCRs for flaviviruses (DENV 1–4, Saint Louis encephalitis virus-SLEV, Bussuquara virus-BSQV and Ilheus virus-ILHV), alphavirus (Mayaro virus-MAYV) and orthobunyavirus (Oropouche virus-OROV).Principal FindingsOnly dengue viruses were detected in 260 patients (38.4%). Thirteen patients were co-infected with more than one DENV serotype and six (46.1%) of them had a more severe clinical presentation of the disease. Nucleotide sequencing showed that DENV-1 belonged to genotype V, DENV-2 to the Asian/American genotype, DENV-3 to genotype III and DENV-4 to genotype II.ConclusionsCo-infection with more than one DENV serotype was observed. This finding should be warning signs to health authorities in situations of the large dispersal of serotypes that are occurring in the world.

Highlights

  • Dengue virus (DENV) infection may display either benign acute febrile illness or severe disease such as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) [1]

  • Co-infection with more than one DENV serotype was observed. This finding should be warning signs to health authorities in situations of the large dispersal of serotypes that are occurring in the world

  • This study describes the clinical epidemiology of dengue in a city where all the four DENV serotypes are co-circulated simultaneously and provides the opportunity to compare clinical severity to DENV serotypes

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Summary

Introduction

Dengue virus (DENV) infection may display either benign acute febrile illness or severe disease such as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) [1]. Dengue virus (DENV) infection may display either benign acute febrile illness or severe disease such as dengue hemorrhagic fever/. Over the last 31 years, Brazil has suffered successive outbreaks of dengue. The incidence of dengue continues to increase, and in the last decade 700,000 cases are reported per year. Dengue outbreaks have displayed many atypical cases such as Severe dengue. Dengue is a vector-borne disease in the tropical and subtropical region of the world and is transmitted by the mosquito Aedes aegypti. In the state of Amazonas, Brazil during the 2011 outbreak of dengue all the four Dengue virus (DENV) serotypes circulating simultaneously were observed. The aim of the study was to describe the clinical epidemiology of dengue in Manaus, the capital city of the state of the Amazonas, where all the four DENV serotypes were co-circulating simultaneously

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