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Investigation Into an Outbreak of Dengue-like Illness in Pernambuco, Brazil, Revealed a Cocirculation of Zika, Chikungunya, and Dengue Virus Type 1

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ABSTRACT

In April 2015, an outbreak of dengue-like illness occurred in Tuparetama, a small city in the northeast region of Brazil; this outbreak was characterized by its fast expansion. An investigation was initiated to identify the viral etiologies and advise the health authorities on implementing control measures to contain the outbreak. This is the first report of this outbreak in the northeast, even though a few cases were documented earlier in a neighboring city.

Plasma samples were obtained from 77 suspected dengue patients attending the main hospital in the city. Laboratory assays, such as real-time reverse transcription polymerase chain reaction, virus cDNA sequencing, and enzyme-linked immunosorbent assay, were employed to identify the infecting virus and molecular phylogenetic analysis was performed to define the circulating viral genotypes.

RNA of Zika virus (ZIKV) and Dengue virus (DENV) or IgM antibodies (Abs) to DENV or chikungunya (CHIKV) were detected in 40 of the 77 plasma samples (51.9%). DENV was found in 9 patients (11.7%), ZIKV was found in 31 patients (40.2%), CHIKV in 1 patient (1.3%), and coinfection of DENV and ZIKV was detected in 2 patients (2.6%). The phylogenetic analysis of 2 available partial DENV and 14 ZIKV sequences revealed the identities of genotype 1 and the Asiatic lineage, respectively.

Consistent with recent reports from the same region, our results showed that the ongoing outbreak is caused by ZIKV, DENV, and CHIKV. This emphasizes the need for a routine and differential diagnosis of arboviruses in patients with dengue-like illness. Coordinated efforts are necessary to contain the outbreak. Continued surveillance will be important to assess the effectiveness of current and future prevention strategies.

No MeSH data available.


Related in: MedlinePlus

Phylogenetic tree constructed using a maximum-likelihood method from a partial NS5 region (689 bp; nt 8912–9601 of PLCal_ZV, GenBank: KF993678) of 14 samples from the present study (indicated by red circles), 51 sequences from Chile and 3 other Asiatic lineages (indicated by blue circle), and the 48 Zika virus sequences originated from Africa (indicated by green square). The tree was generated by the ML method using the TN93 + G + I model implemented in the PHYML v.3.0 package. The approximate likelihood ratio test (aLRT) values of at least 63% are indicated at nodes. The tree was rooted with the dengue virus (GenBank: KJ18936) genotype 1 from Puerto Rico.
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Figure 3: Phylogenetic tree constructed using a maximum-likelihood method from a partial NS5 region (689 bp; nt 8912–9601 of PLCal_ZV, GenBank: KF993678) of 14 samples from the present study (indicated by red circles), 51 sequences from Chile and 3 other Asiatic lineages (indicated by blue circle), and the 48 Zika virus sequences originated from Africa (indicated by green square). The tree was generated by the ML method using the TN93 + G + I model implemented in the PHYML v.3.0 package. The approximate likelihood ratio test (aLRT) values of at least 63% are indicated at nodes. The tree was rooted with the dengue virus (GenBank: KJ18936) genotype 1 from Puerto Rico.

Mentions: Of the 31 plasma samples positive for ZIKV by qRT-PCR, the partial NS5 fragment from 14 samples was successfully genotyped. Sequence comparisons showed high degrees of identity among the 14 sequences; the paired identity at the nucleotide level ranged from 99.4% to 100%. When sequences were compared with ZIKV sequences, including recently published viral sequences from Chile34 and Asia,35 the identity values were 99.3% and 98.6% in the partial NS5 gene, respectively. When the sequences were compared with ZIKV sequences from West Africa, the nucleotide identities was 83.1%. The ML phylogenetic tree was then constructed using the 14 fragments sequenced in this study, the 51 sequences from Chile, and 51 other sequences from other parts of the world including West Africa. The ML tree depicted in Figure 3 shows the Brazilian ZIKV sequences formed a monophyletic cluster (63% aLRT) that groups with ZIKV from Chile (72% aLRT). This Latin American ZIKV cluster demonstrates strong clustering (86% aLRT) to the Asian lineages characterized in French Polynesia in 2013,36 as shown in Figure 3.


Investigation Into an Outbreak of Dengue-like Illness in Pernambuco, Brazil, Revealed a Cocirculation of Zika, Chikungunya, and Dengue Virus Type 1
Phylogenetic tree constructed using a maximum-likelihood method from a partial NS5 region (689 bp; nt 8912–9601 of PLCal_ZV, GenBank: KF993678) of 14 samples from the present study (indicated by red circles), 51 sequences from Chile and 3 other Asiatic lineages (indicated by blue circle), and the 48 Zika virus sequences originated from Africa (indicated by green square). The tree was generated by the ML method using the TN93 + G + I model implemented in the PHYML v.3.0 package. The approximate likelihood ratio test (aLRT) values of at least 63% are indicated at nodes. The tree was rooted with the dengue virus (GenBank: KJ18936) genotype 1 from Puerto Rico.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998417&req=5

Figure 3: Phylogenetic tree constructed using a maximum-likelihood method from a partial NS5 region (689 bp; nt 8912–9601 of PLCal_ZV, GenBank: KF993678) of 14 samples from the present study (indicated by red circles), 51 sequences from Chile and 3 other Asiatic lineages (indicated by blue circle), and the 48 Zika virus sequences originated from Africa (indicated by green square). The tree was generated by the ML method using the TN93 + G + I model implemented in the PHYML v.3.0 package. The approximate likelihood ratio test (aLRT) values of at least 63% are indicated at nodes. The tree was rooted with the dengue virus (GenBank: KJ18936) genotype 1 from Puerto Rico.
Mentions: Of the 31 plasma samples positive for ZIKV by qRT-PCR, the partial NS5 fragment from 14 samples was successfully genotyped. Sequence comparisons showed high degrees of identity among the 14 sequences; the paired identity at the nucleotide level ranged from 99.4% to 100%. When sequences were compared with ZIKV sequences, including recently published viral sequences from Chile34 and Asia,35 the identity values were 99.3% and 98.6% in the partial NS5 gene, respectively. When the sequences were compared with ZIKV sequences from West Africa, the nucleotide identities was 83.1%. The ML phylogenetic tree was then constructed using the 14 fragments sequenced in this study, the 51 sequences from Chile, and 51 other sequences from other parts of the world including West Africa. The ML tree depicted in Figure 3 shows the Brazilian ZIKV sequences formed a monophyletic cluster (63% aLRT) that groups with ZIKV from Chile (72% aLRT). This Latin American ZIKV cluster demonstrates strong clustering (86% aLRT) to the Asian lineages characterized in French Polynesia in 2013,36 as shown in Figure 3.

View Article: PubMed Central - PubMed

ABSTRACT

In April 2015, an outbreak of dengue-like illness occurred in Tuparetama, a small city in the northeast region of Brazil; this outbreak was characterized by its fast expansion. An investigation was initiated to identify the viral etiologies and advise the health authorities on implementing control measures to contain the outbreak. This is the first report of this outbreak in the northeast, even though a few cases were documented earlier in a neighboring city.

Plasma samples were obtained from 77 suspected dengue patients attending the main hospital in the city. Laboratory assays, such as real-time reverse transcription polymerase chain reaction, virus cDNA sequencing, and enzyme-linked immunosorbent assay, were employed to identify the infecting virus and molecular phylogenetic analysis was performed to define the circulating viral genotypes.

RNA of Zika virus (ZIKV) and Dengue virus (DENV) or IgM antibodies (Abs) to DENV or chikungunya (CHIKV) were detected in 40 of the 77 plasma samples (51.9%). DENV was found in 9 patients (11.7%), ZIKV was found in 31 patients (40.2%), CHIKV in 1 patient (1.3%), and coinfection of DENV and ZIKV was detected in 2 patients (2.6%). The phylogenetic analysis of 2 available partial DENV and 14 ZIKV sequences revealed the identities of genotype 1 and the Asiatic lineage, respectively.

Consistent with recent reports from the same region, our results showed that the ongoing outbreak is caused by ZIKV, DENV, and CHIKV. This emphasizes the need for a routine and differential diagnosis of arboviruses in patients with dengue-like illness. Coordinated efforts are necessary to contain the outbreak. Continued surveillance will be important to assess the effectiveness of current and future prevention strategies.

No MeSH data available.


Related in: MedlinePlus