Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay

• Authors: Alejandra Rojas, Universidad Nacional de Asunción; Fatima Cardozo, Universidad Nacional de Asunción; Cesar Cantero, Universidad Nacional de Asunción; Victoria Stittleburg, Emory University; Sanny Lopez, Universidad Nacional de Asunción; Cynthia Bernal, Universidad Nacional de Asunción; Francisco Eugenio Gimenez Acosta, Hospital Distrial de Villa Elisa; Laura Mendoza, Universidad Nacional de Asunción; Benjamin A. Pinsky, Stanford University; Ivalena Arevalo de Guillen, Universidad Nacional de Asunción; Malvina Paez, Universidad Nacional de Asunción; Jesse Waggoner, Emory University
• Journal Title: PeerJ
• Volume: Volume 7, Number 10
• Publisher: PeerJ Inc. | 2019-10-09, Pages e7852-e7852
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7717/peerj.7852
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; Dengue virus; NS1; RT-PCR; Diagnosis; Hospitalization; Anti-NS1 antibody; Viral load; SEROTYPE-SPECIFIC DIFFERENCES; REVERSE TRANSCRIPTION-PCR; EARLY CLINICAL-FEATURES; LABORATORY FEATURES; NS1 ANTIGEN; NONSTRUCTURAL PROTEIN-1; FEBRILE ILLNESSES; VIRUS-INFECTION; SINGLE-REACTION; DISEASE

Abstract

Background. In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. Methods. Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). Results. A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0–0.3). Conclusions. Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.