Abstract
Dengue virus (DENV) circulates in human and sylvatic cycles. Sylvatic strains are both ecologically and evolutionarily distinct from endemic viruses. Although sylvatic dengue cycles occur in West African countries and Malaysia, only a few cases of mild human disease caused by sylvatic strains and one single case of dengue hemorrhagic fever in Malaysia have been reported. Here we report a case of dengue hemorrhagic fever (DHF) with thrombocytopenia (13000/µl), a raised hematocrit (32% above baseline) and mucosal bleeding in a 27-year-old male returning to Spain in November 2009 after visiting his home country Guinea Bissau. Sylvatic DENV-2 West African lineage was isolated from blood and sera. This is the first case of DHF associated with sylvatic DENV-2 in Africa and the second case worldwide of DHF caused by a sylvatic strain.
Highlights
Dengue viruses (DENV) are the most widely distributed arboviruses in the world
Retrospective analysis of human serum samples collected in Nigeria from the 1960s proved that sylvatic dengue was able to cause an outbreak of dengue fever in human population
A case of dengue hemorrhagic fever (DHF) in Asia was linked to sylvatic DENV-2 infection
Summary
Dengue viruses (DENV) are the most widely distributed arboviruses in the world. The four distinct serotypes belong to the family Flaviviridae and are some of the most important vectorborne pathogens of humans [1]. DENV circulation occurs in two cycles: an endemic/epidemic cycle between humans and peridomestic mosquitoes, Aedes aegypti and Ae. albopictus, and a sylvatic enzootic cycle between non-human primates and several arboreal Aedes species. In Asia, circulation of sylvatic DENV-1, -2 and -4 has been detected in Ae. niveus mosquitoes and/or sentinel monkeys [2]. Sylvatic DENV-3 strains have not been isolated to date, they are believed to circulate in Malaysia based on seroconversion of sentinel monkeys [3,4]. DENV strains could be introduced in naıve countries with the potential to develop limited or even extensive outbreaks, such as occurred with the introduction of Chikungunya virus in Italy in 2007 [37]. We described here the first case of DHF grade II caused by a sylvatic DENV-2 belonging to a West African lineage virus. The findings suggest that sylvatic strains of DENV might have a greater pathogenic potential than previously thought [19]
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