Abstract
In the context of recent arbovirus epidemics, questions about the frequency of simultaneous infection of patients with different arbovirus species have been raised. In 2014, a major Chikungunya virus (CHIKV) epidemic impacted the Caribbean and South America. As part of ongoing screening of schoolchildren presenting with acute undifferentiated febrile illness in rural Haiti, we used RT-PCR to identify CHIKV infections in 82 of 100 children with this diagnosis during May—August 2014. Among these, eight were infected with a second arbovirus: six with Zika virus (ZIKV), one with Dengue virus serotype 2, and one with Mayaro virus (MAYV). These dual infections were only detected following culture of the specimen, suggesting low viral loads of the co-infecting species. Phylogenetic analyses indicated that the ZIKV and MAYV strains differ from those detected later in 2014 and 2015, respectively. Moreover, CHIKV and ZIKV strains from co-infected patients clustered monophyletically in their respective phylogeny, and clock calibration traced back the common ancestor of each clade to an overlapping timeframe of introduction of these arboviruses onto the island.
Highlights
Chikungunya virus (CHIKV), is the causative agent of chikungunya fever
All rtRT-PCR-confirmed CHIKV infections in our student cohort occurred in the 9-week period between May 23 and July 25, 2014; the one “outlier” case occurred in mid-August, 2014
Among the 100 plasma specimens taken from febrile schoolchildren in the May-August time period, 82 tested positive via rtRT-PCR for CHIKV, but were negative for DENV1-4 and Zika virus (ZIKV)
Summary
Chikungunya virus (CHIKV) (family Togaviridae, genus Alphavirus), is the causative agent of chikungunya fever. After first isolation of CHIKV in 1952 in present-day Tanzania, outbreaks and epidemics were limited to regions of Asia, Africa, and the Pacific Islands. The acute symptoms of CHIKV infection are similar to those of infection with other arbovirus species, including Dengue virus (DENV), Zika virus (ZIKV), and Mayaro virus (MAYV), each presenting with a constellation of symptoms including fever, headache, and myalgias/arthralgias. The similarity of the clinical presentation of acute-phase arbovirus infections is further complicated by the potential for simultaneous infection with multiple arboviruses. In a recent literature review, co-infections with CHIKV and DENV ranged from 1% to 34% of patients [6]. Virtually no data are available on frequency of co-infection with CHIKV and arboviruses other than DENV. Even where good laboratory diagnostic facilities are available, identification of co-infections often does not occur, as there is a tendency to cease investigation once an initial pathogen has been identified, and/or identification of a second pathogen may require facilities for virus isolation, which may not be available
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