Morais, Vanessa dos Santos, Reis Santana, Lídia Maria, Bezerra, João Felipe, Cruz, Flavia Emmanuelle, Rocha de Souza, Themis, Tahmasebi, Roozbeh, Alves Raposo, Rafael Augusto, Marcatti, Roberta, Garcia Barbosa, Erick Matheus, Hefford, Philip Michael, Buccheri, Renata, Cerdeira Sabino, Ester, and Charlys da Costa, Antonio
Background: Arthropod-borne viruses, known as arboviruses, pose substantial risks to global public health. Dengue (DENV), Chikungunya (CHIKV) and Zika (ZIKV) viruses stand out as significant concerns in Brazil and worldwide. Their overlapping clinical manifestations make accurate diagnosis a challenge, underscoring the need for reliable laboratory support. This study employs a comprehensive molecular diagnostic approach to track viral infections in individuals with acute febrile illness, a period marked by widespread outbreaks of DENV, CHIKV and ZIKV. Methods: Between January and August 2016, we received a total of 713 serum samples obtained from individuals with acute febrile illness, previously tested for DENV, CHIKV or ZIKV, with initial negative results, from LACEN-NATAL. Of the total 713 samples, 667 were from females (354 of them pregnant) and 46 from males. Molecular diagnosis was conducted using the Multiplex RT-qPCR technique for simultaneous detection of DENV, CHIKV and ZIKV. Additionally, we performed differential diagnosis by RT-qPCR for other viruses of the Flavivirus, Alphavirus Enterovirus genera and qPCR for Primate Erythroparvovirus 1 (B19V) species, in accordance with Ministry of Health guidelines. Results: Among the 713 cases, 78.2% tested positive for viral infections, including 48% with CHIKV viremia, 0.6% with DENV and 0.1% with ZIKV. Arboviral coinfections totaled 2.4%, including DENV-CHIKV (1.7%) and CHIKV-ZIKV (0.7%). Moreover, 8% exhibited B19V viremia. Simultaneous infections were identified in 17.5%, encompassing B19V-CHIKV (17.1%), B19V-DENV (0.1%), and B19V-ZIKV (0.3%) Triple infections were observed in 1.3% of cases with B19V-DENV-CHIKV (1%) and B19V-CHIKV-ZIKV (0.3%). Conclusion: Molecular testing demonstrated high efficacy in diagnosing prevalent arboviruses and detecting multiple coinfections. This approach helps to elucidate etiologies for symptomatic cases, especially during arbovirus outbreaks, and aids comprehensive surveillance. Our findings underscore the importance of monitoring co-circulating pathogens, such as B19V, with implications for clinical management, particularly in pregnant individuals. This study enhances our understanding of arbovirus epidemiology and reinforces the critical role of molecular diagnosis in disease surveillance and control. Author summary: Fever is one of the most common reasons for seeking health care in Latin America and is a substantial contributor to continental morbidity and mortality. Viruses transmitted by arthropods, known as arboviruses, represent one of the predominant etiologic agents responsible for causing febrile illness in Latin America. In the current epidemiological scenario in Brazil, due to shared characteristics of DENV, CHIKV and ZIKV, the Ministry of Health recommends performing a differential diagnosis for other clinical syndromes. In this study, we performed the differential molecular diagnosis in 713 samples of individuals with acute febrile illness suspected of arboviruses belonging to the state of Rio Grande do Norte in 2016. The samples were submitted to RT-qPCR and qPCR tests for DENV, CHIKV and ZIKV, together with other agents responsible for causing febrile syndrome and exanthematous fever syndrome. These include Enterovirus, other arboviruses of the Flavivirus and Alphavirus genera and the species Primate Erythroparvovirus 1 (B19V). We report the concomitant detection of CHIKV and B19V in 17.1% of cases, highlighting the importance of a broad diagnostic approach, since the detection of simultaneous infections may be occurring between arboviruses and/ or other viruses during epidemics in different regions of Brazil. [ABSTRACT FROM AUTHOR]