Viremia and Clinical Presentation in Nicaraguan Patients Infected With Zika Virus, Chikungunya Virus, and Dengue Virus

• Type of Material: Article
• Authors: Jesse Waggoner, Emory University; Lionel Gresh, Sustainable Sciences Institute; Maria Jose Jose Vargas, Ministry of Health, Nicaragua; Gabriela Ballesteros, Ministry of Health, Nicaragua; Yolanda Tellez, Ministry of Health, Nicaragua; K. James Soda, Florida State University; Malaya K. Sahoo, Stanford University; Andrea Nunez, Ministry of Health, Nicaragua; Angel Balmaseda, Ministry of Health, Nicaragua; Eva Harris, University of California Berkeley; Benjamin A. Pinsky, Stanford University
• Language: English
• Date: 2016-12-15
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciw589
• Title of Journal or Parent Work: Clinical Infectious Diseases
• ISSN: 1058-4838
• Volume: 63
• Issue: 12
• Start Page: 1584
• End Page: 1590
• Grant/Funding Information: Studies in Nicaragua were supported by NIH (R01AI099631;; A. B. and U54AI65359; A. B.).; This work was supported by National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH) (K08AI110528; J. J. W.).
• Keywords: Coinfection; SEVERITY; Viremia; TIME RT-PCR; Microbiology; CORRELATE; Life Sciences & Biomedicine; Medical; Surveillance; Dengue virus; Viruses; REVERSE TRANSCRIPTION-PCR; coinfection; EPIDEMIC; Diagnosis; Science & Technology; Zika virus; chikungunya virus; Immunology; dengue virus; SINGLE-REACTION; Infectious Diseases; COINFECTION; MULTIPLEX; ASSAY; Polymerase chain reaction; CHILDREN; viremia
• Research Categories: Biology, Virology; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

BACKGROUND:  Zika virus (ZIKV), chikungunya virus (CHIKV), and dengue virus (DENV) cocirculate in Nicaragua. In this study, we sought to compare the quantified viremia and clinical presentation of patients infected with 1 or more of these viruses. METHODS:  Acute-phase serum samples from 346 patients with a suspected arboviral illness were tested using a multiplex real-time reverse-transcription polymerase chain reaction for ZIKV, CHIKV, and DENV. Viremia was quantitated for each detected virus, and clinical information from request forms submitted with each sample was recorded. RESULTS:  A total of 263 patients tested positive for 1 or more viruses: 192 patients tested positive for a single virus (monoinfections) and 71 patients tested positive for 2 or all 3 viruses (coinfections). Quantifiable viremia was lower in ZIKV infections compared with CHIKV or DENV (mean 4.70 vs 6.42 and 5.84 log10 copies/mL serum, respectively; P < .001 for both comparisons), and for each virus, mean viremia was significantly lower in coinfections than in monoinfections. Compared with patients with CHIKV or DENV, ZIKV patients were more likely to have a rash (P < .001) and less likely to be febrile (P < .05) or require hospitalization (P < .001). Among all patients, hospitalized cases had higher viremia than those who did not require hospitalization (7.1 vs 4.1 log10 copies/mL serum, respectively; P < .001). CONCLUSIONS:  ZIKV, CHIKV, and DENV result in similar clinical presentations, and coinfections may be relatively common. Our findings illustrate the need for accurate, multiplex diagnostics for patient care and epidemiologic surveillance.