gms | German Medical Science

Research question: Acute febrile illness in subtropical and tropical countries like Colombia is frequently caused by arboviruses and malaria. Children in low-resource settings are especially vulnerable. The uncharacteristic clinical manifestation of vector-borne diseases can lead to wrong diagnoses and inadequate treatment decisions like the overuse of antimalarial and/or antibiotic drugs. Globalization, migration, and climate change are facilitating the spread of arboviruses and malaria to previously non-endemic regions, making them a global public health problem.

Methods: The University Medical Centre of Mainz department for paediatric infectiology developed a 9-valent-RT-PCR-ELISA, designed to detect malaria and 8 arboviruses including Zika, Dengue and Chikungunya. 155 patients with acute febrile symptoms were recruited from rural areas of Colombia’s Urabá and Chocó regions. They received a physical examination, and malaria and dengue rapid tests were performed. Blood, plasma, and serum samples were obtained for subsequent testing with the 9-valent-RT-PCR-ELISA.

Results: 53 out of 155 patients were 17 years or younger. The average age for patients with dengue in the study group was 11.9 years, the average for patients with malaria 32.2 years with the overall age average being 28.1 years. Out of all patients, 25 were rapid-test positive for malaria. These 21 cases were confirmed with the RT-PCR-ELISA panel. A total of 16 patients had positive rapid tests for dengue, of which 13 could be confirmed by the RT-PCR-ELISA. The arboviral pathogens could not be detected from dried blood spot samples. Further analysis with a RT-PCR for dengue serotypes confirmed all 16 rapid test positive cases and showed that out of the 16 cases, two samples were positive for dengue virus serotype 1, one sample was positive for serotype 2, four samples were positive for serotype 3 and the other 9 samples were coinfections with serotypes 1 and 4.

Discussion: Arboviruses and malaria pose a great threat to public health in Colombia and on a global scale. Early detection and a correct diagnosis are essential for optimal patient care. 80% of this study’s dengue cases were children below the age of 14, supporting current literature stating that children are especially vulnerable to dengue infection. The RT-PCR-ELISA used in this study displayed the prevalence of malaria and dengue in the study sites. Subsequent analysis of dengue positive samples proved the coexistence of serotypes 1.3 and 4 at the study sites and coinfections with serotypes 1 and 4 occurring. Rapid tests proved to be a reliable diagnostic tool both for malaria and dengue. Dried blood spots on filter cards were not suitable for preservation of arboviral RNA. Importantly, relevant vector borne pathogens such as Leishmania or Trypanosoma still need to be implemented in the panel.