Abstract
Fever is a common symptom of many tropical diseases and in many cases the etiologic agent remains unidentified as a consequence of either the etiologic agent not being part of routine diagnostic screening or as a consequence of false negatives on standard diagnostic tests. This study screened a well characterized panel of 274 serum samples collected on day of admission from adult patients with acute undifferentiated fever admitted to a hospital in Nakhon Ratchasima, Thailand by RT-PCR using pan-flavivirus degenerate primers. Subsequent clinical diagnosis was achieved for 38 of the patients, and included 19 cases of dengue fever. RT-PCR screening identified seven positive samples (2.5%) which were revealed by sequence analysis to be dengue virus 1 (2 cases), dengue virus 2 (2 cases) and dengue virus 3 (3 cases). Only 5 out of 19 (26%) serum samples from patients subsequently diagnosed with dengue were positive, but 2 samples which clinically remained undiagnosed were shown to be positive for dengue virus. Sequence analysis suggested that the dengue virus 3 cases occurred as a result of importation of a strain of dengue from India or China. No other flaviviruses were identified. No evidence was found of other flaviviruses besides dengue circulating in this population. Despite improved diagnostic tests, cases of dengue are still evading correct diagnosis.
Highlights
Fever is a common symptom of many tropical diseases and in many cases the etiologic agent remains unidentified as a consequence of either the etiologic agent not being part of routine diagnostic screening or as a consequence of false negatives on standard diagnostic tests
A total of 274 serum samples taken on day of admission from adult patients with acute undifferentiated fever collected at a hospital in Northeastern Thailand were screened with universal degenerate primers capable of detecting all known flaviviruses [11]
Sequence analysis confirmed that all samples were positive for Dengue virus (DENV), and that three of the samples were positive for DENV 3, two samples were positive for DENV 1 and two were positive for DENV 2
Summary
Fever is a common symptom of many tropical diseases and in many cases the etiologic agent remains unidentified as a consequence of either the etiologic agent not being part of routine diagnostic screening or as a consequence of false negatives on standard diagnostic tests. Results: Subsequent clinical diagnosis was achieved for 38 of the patients, and included 19 cases of dengue fever. The known species of flaviviruses include a number of internationally important human pathogens, including Yellow fever virus, Dengue virus (DENV), Japanese encephalitis virus (JEV), West Nile virus and Tick Borne Encephalitis virus [1]. Zika virus (assigned to the Spondweni virus group) is believed to have been circulating in Southeast Asia for some 50 years [4] and a case of Zika fever was diagnosed in Cambodia in 2010 [5]. It is possible that cases of flavivirus infection by viruses other than DENV and JEV have not been reported in Thailand because these other viruses are not part of the normal spectrum of infections encountered, and specific diagnostic tests are not available for these viruses
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