1789. Frequency of Chikungunya, Dengue, and Zika Virus in Acute Febrile Illness in Paired Urine and Serum Samples in Mexico

Abstract

Background. Given the nonspecific clinical presentation that dengue (DENV), Zika (ZIKV), and chikungunya viruses (CHIKV) have, nucleic acid amplification tests have become the primary diagnostic tool. Multiplex real-time PCR assays have been approved for their use in the qualitative detection of ZIKV in urine but there are few data regarding CHIKV and DENV. We report the frequencies of PCR detection for DENV, ZIKV and CHIKV in paired urine and serum samples in Mexico. Methods. We included patients with acute febrile illness from five centers, located in Guadalajara and Monterrey, from September 2016 to December 2018. Viral RNA was extracted from samples, reverse transcribed and subjected to real-time PCRs specific for DENV, CHIKV, and ZIKV. Patients were considered a positive case if any of the three tests were positive. The obtained data were analyzed using descriptive statistics. Results. A total of 978 patients were included. A positive result was obtained in 331 patients (33.84%): 184 for ZIKV, 129 for DENV, and 18 for CHIKV. The tests were positive in both specimens in 56 (30.4%), 29 (22.4%), and 4 (22%) of the cases, respectively, while an isolated positive urine test was found in 74 (40%), 5 (3%) and 4 (22%) of the cases. Two patients were positive for both ZIKV and DENV, and two were positive for both ZIKV and CHIKV. Conclusion. Acute febrile illness was potentially attributable to infection with one or two of the studied arboviruses in up to 34% of our patients. Out of all the cases, 25% were positive only in urine samples. Therefore, some diagnosis could be missed when analyzing only serum-based tests. Paired serum and urine sampling should be recommended when detecting arbovirus in acute febrile illness.