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

December 11, 2016 at 12:00 pm

Clinical Infectious Diseases December 15, 2016 V.63 N.12 P.1584-1590

Jesse J. Waggoner, Lionel Gresh, Maria Jose Vargas, Gabriela Ballesteros, Yolanda Tellez, K. James Soda, Malaya K. Sahoo, Andrea Nuñez, Angel Balmaseda, Eva Harris, and Benjamin A. Pinsky

1Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California

2Sustainable Sciences Institute

3National Virology Laboratory, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua

4Department of Scientific Computing, Florida State University, Tallahassee

5Department of Pathology, Stanford University School of Medicine

6Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley


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.


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.


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).


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.



Entry filed under: Biología Molecular, Epidemiología, FIEBRE en el POST-VIAJE, FIEBRE y RASH, Infecciones emergentes, Infecciones en embarzadas, Infecciones virales, Medicina del viajero, Metodos diagnosticos, Sepsis, Update, Zoonosis.

IDSA GUIDELINE – Diagnosis and Treatment of Leishmaniasis – Clinical Practice Guidelines by the IDSA and ASTMH CID Editor’s Choice – The Molecular Epidemiology and Antimicrobial Resistance of Neisseria gonorrhoeae in Australia: A Nationwide Cross-Sectional Study, 2012


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