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Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study
BACKGROUND: Dengue virus (DENV) infection is a major cause of acute febrile illness in Indonesia. Diagnostic inaccuracy may occur due to its varied and non-specific presentation. Characterization of DENV epidemiology, clinical presentation, and virology will facilitate appropriate clinical managemen...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822776/ https://www.ncbi.nlm.nih.gov/pubmed/31634352 http://dx.doi.org/10.1371/journal.pntd.0007785 |
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author | Utama, I Made Susila Lukman, Nurhayati Sukmawati, Dewi Dian Alisjahbana, Bachti Alam, Anggraini Murniati, Dewi Utama, I Made Gede Dwi Lingga Puspitasari, Dwiyanti Kosasih, Herman Laksono, Ida Karyana, Muhammad Karyanti, Mulya Rahma Hapsari, M. M. D. E. A. H. Meutia, Ninny Liang, C Jason Wulan, Wahyu Nawang Lau, Chuen-Yen Parwati, Ketut Tuti Merati |
author_facet | Utama, I Made Susila Lukman, Nurhayati Sukmawati, Dewi Dian Alisjahbana, Bachti Alam, Anggraini Murniati, Dewi Utama, I Made Gede Dwi Lingga Puspitasari, Dwiyanti Kosasih, Herman Laksono, Ida Karyana, Muhammad Karyanti, Mulya Rahma Hapsari, M. M. D. E. A. H. Meutia, Ninny Liang, C Jason Wulan, Wahyu Nawang Lau, Chuen-Yen Parwati, Ketut Tuti Merati |
author_sort | Utama, I Made Susila |
collection | PubMed |
description | BACKGROUND: Dengue virus (DENV) infection is a major cause of acute febrile illness in Indonesia. Diagnostic inaccuracy may occur due to its varied and non-specific presentation. Characterization of DENV epidemiology, clinical presentation, and virology will facilitate appropriate clinical management and public health policy. METHODOLOGY/PRINCIPAL FINDINGS: A multicenter observational cohort study was conducted in Indonesia to assess causes of acute fever requiring hospitalization. Clinical information and specimens were collected at enrollment, 14–28 days, and 3 months from 1,486 children and adults. Total of 468 (31.9%) cases of DENV infection were confirmed by reference laboratory assays. Of these, 414 (88.5%) were accurately diagnosed and 54 had been misdiagnosed as another infection by sites. One hundred initially suspected dengue cases were finally classified as ‘non-dengue’; other pathogens were identified in 58 of those cases. Mortality of DENV infection was low (0.6%). Prior DENV exposure was found in 92.3% of subjects >12 years. DENV circulated year-round in all cities, with higher incidence from January to March. DENV-3 and DENV-1 were the predominant serotypes. This study identified DENV-1 with TS1(19)(C→T) substitution in the serotyping primer annealing site, leading to failure of serotype determination. CONCLUSIONS/SIGNIFICANCE: DENV is a common etiology of acute febrile illness requiring hospitalization in Indonesia. Diagnostic accuracy at clinical sites merits optimization since misdiagnosis of DENV infection and over-estimation of dengue can negatively impact management and outcomes. Mutation at the annealing site of the serotyping primer may confound diagnosis. Clinicians should consider following diagnostic algorithms that include DENV confirmatory testing. Policy-makers should prioritize development of laboratory capacity for diagnosis of DENV. |
format | Online Article Text |
id | pubmed-6822776 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-68227762019-11-12 Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study Utama, I Made Susila Lukman, Nurhayati Sukmawati, Dewi Dian Alisjahbana, Bachti Alam, Anggraini Murniati, Dewi Utama, I Made Gede Dwi Lingga Puspitasari, Dwiyanti Kosasih, Herman Laksono, Ida Karyana, Muhammad Karyanti, Mulya Rahma Hapsari, M. M. D. E. A. H. Meutia, Ninny Liang, C Jason Wulan, Wahyu Nawang Lau, Chuen-Yen Parwati, Ketut Tuti Merati PLoS Negl Trop Dis Research Article BACKGROUND: Dengue virus (DENV) infection is a major cause of acute febrile illness in Indonesia. Diagnostic inaccuracy may occur due to its varied and non-specific presentation. Characterization of DENV epidemiology, clinical presentation, and virology will facilitate appropriate clinical management and public health policy. METHODOLOGY/PRINCIPAL FINDINGS: A multicenter observational cohort study was conducted in Indonesia to assess causes of acute fever requiring hospitalization. Clinical information and specimens were collected at enrollment, 14–28 days, and 3 months from 1,486 children and adults. Total of 468 (31.9%) cases of DENV infection were confirmed by reference laboratory assays. Of these, 414 (88.5%) were accurately diagnosed and 54 had been misdiagnosed as another infection by sites. One hundred initially suspected dengue cases were finally classified as ‘non-dengue’; other pathogens were identified in 58 of those cases. Mortality of DENV infection was low (0.6%). Prior DENV exposure was found in 92.3% of subjects >12 years. DENV circulated year-round in all cities, with higher incidence from January to March. DENV-3 and DENV-1 were the predominant serotypes. This study identified DENV-1 with TS1(19)(C→T) substitution in the serotyping primer annealing site, leading to failure of serotype determination. CONCLUSIONS/SIGNIFICANCE: DENV is a common etiology of acute febrile illness requiring hospitalization in Indonesia. Diagnostic accuracy at clinical sites merits optimization since misdiagnosis of DENV infection and over-estimation of dengue can negatively impact management and outcomes. Mutation at the annealing site of the serotyping primer may confound diagnosis. Clinicians should consider following diagnostic algorithms that include DENV confirmatory testing. Policy-makers should prioritize development of laboratory capacity for diagnosis of DENV. Public Library of Science 2019-10-21 /pmc/articles/PMC6822776/ /pubmed/31634352 http://dx.doi.org/10.1371/journal.pntd.0007785 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Utama, I Made Susila Lukman, Nurhayati Sukmawati, Dewi Dian Alisjahbana, Bachti Alam, Anggraini Murniati, Dewi Utama, I Made Gede Dwi Lingga Puspitasari, Dwiyanti Kosasih, Herman Laksono, Ida Karyana, Muhammad Karyanti, Mulya Rahma Hapsari, M. M. D. E. A. H. Meutia, Ninny Liang, C Jason Wulan, Wahyu Nawang Lau, Chuen-Yen Parwati, Ketut Tuti Merati Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study |
title | Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study |
title_full | Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study |
title_fullStr | Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study |
title_full_unstemmed | Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study |
title_short | Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study |
title_sort | dengue viral infection in indonesia: epidemiology, diagnostic challenges, and mutations from an observational cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822776/ https://www.ncbi.nlm.nih.gov/pubmed/31634352 http://dx.doi.org/10.1371/journal.pntd.0007785 |
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