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CORRESPONDENCE
Year : 2015  |  Volume : 33  |  Issue : 3  |  Page : 459-460
 

Co-infections with chikungunya and dengue viruses: A serological study in Karnataka State, India


National Institute of Virology, Bangalore Unit [ICMR], Rajiv Gandhi Institute of Chest Diseases Premises, Bangalore, Karnataka, India

Date of Submission25-May-2014
Date of Acceptance12-Nov-2014
Date of Web Publication12-Jun-2015

Correspondence Address:
N Shaikh
National Institute of Virology, Bangalore Unit [ICMR], Rajiv Gandhi Institute of Chest Diseases Premises, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.158607

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How to cite this article:
Shaikh N, Raut C G, Manjunatha M. Co-infections with chikungunya and dengue viruses: A serological study in Karnataka State, India. Indian J Med Microbiol 2015;33:459-60

How to cite this URL:
Shaikh N, Raut C G, Manjunatha M. Co-infections with chikungunya and dengue viruses: A serological study in Karnataka State, India. Indian J Med Microbiol [serial online] 2015 [cited 2019 Nov 21];33:459-60. Available from: http://www.ijmm.org/text.asp?2015/33/3/459/158607


Dear Editor,

Diseases due to arboviruses are one of the major public health problems worldwide. Out of many arboviruses, chikungunya virus (CHIKV) and dengue virus (DENV) are the two most rapidly spreading and medical health important. Both the diseases have some common signs and symptoms which include fever with chills, swelling of major and minor joint with pain, difficult to move limbs, nausea, headache and vomiting and sometime appearance of rashes. To date, both CHIK and DENV are co-circulating in India and Southeast Asia. [1] Co-circulation of CHIKV and DENV is not uncommon in Southeast Asia. [2],[3] In India, concurrent isolation of CHIKV and DENV had been reported since 1964 from different states. [2],[4]

The aim of our study was to compare the clinical feature of CHIK, DENV and co-infection cases and detection of IgM-antibodies-in infected patients in Karnataka state. The samples were referred by the district health authority and by the clinicians of different hospitals and from the admitted cases. The patients were having typical clinical history of CHIK and DEN infection like high fever (>39°C) with chills, rashes, joint pain, swelling of joints, nausea/vomiting, headache, myalgia and retro-orbital pain. Severe arthralgia and swelling of joints were common only in CHIKV-positive cases and where abdominal pain was mainly associated with DENV infection. As compared to other symptoms, diarrhoea was reported only in the dual infected patients. [5] All the samples were subjected to Enzyme Linked Immunosorbent assay (ELISA) test to detect the presence of immunoglobulin M (IgM) antibodies against both CHIK and DENV.

A total of 6,554 blood samples were collected from different government hospital, private institutes as well as admitted cases. All these were clinically suspected cases of DENV/CHIKV and were in the acute phase. The blood samples were tested for the detection of IgM antibody against CHIKV, DENV and dual infection. Most of the samples were collected during 1 to 10 days of onset of the illness. Approximately 2-5 ml of blood was collected, serum separated and subjected to ELISA. IgM antibody capture (MAC) ELISA was performed using kit from National Institute of Virology (NIV), Pune. Dengue (DEN) and Chikungunya IgM Capture ELISA kit (In-house kit). The test was standardized and reported by National Institute of Virology, Pune in 1984. [6] The performance of the test was evaluated by Christian Medical College (CMC), Vellore in 2002. [7]

In our study, out of 6,554 samples, 3,202 (48.9%) samples showed IgM antibodies to dengue virus [Table 1]. Year-wise study shows that a large portion of the population is exposed to dengue infection which is reflected by the high prevalence of dengue positivity in Karnataka state. In our study, dual infection varies from 5.7-9.5% which is quite interesting.
Table 1: CHIKV, DENV and co-infection infection tested by IgM ELISA


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An extensive increase in CHIKV cases along with DENV were recorded in 2010 outbreak. In our study, dual infection is seen more in adult group than the children group, which is also documented by others. [5]

Co-infections may result in illness with overlapping signs and symptoms, making diagnosis and treatment difficult for physicians. The possible reason for dual infection may be because in Karnataka the mosquitoes Ae. aegypti and Ae. albopictus are abundantly present. There are few studies done on dual infection indifferent countries like Malaysia, Sri Lanka, [1],[8] which are supporting our findings and are also reported from some part of India, showing patients co-infected with CHIKV and DENV. [4],[5] In our study, as far as isolation of the virus is concern, only DENV could be isolated from few samples received for study but Chikungunya virus could not be isolated from the same sample this could due to virus load present in the sample. Molecular analysis are required for the further studies. Successful isolation of both is needed to conduct basic and applied research on CHIKV and DENV biology. Presently no specific therapy and vaccine is available against both type of infection, hence detection of the aetiology of an outbreak at the initial stage is very important. Circulation of CHIKV is seen in dengue epidemic area. DENV can cause severe haemorrhagic illness and CHIK, although generally 'benign', but can cause severe neurological illness. Therefore, further epidemiological and virological investigations for both viruses are required, because these may create devastative effects, particularly in children and young adults who may not possess the CHIKV and DENV antibody. The clinical manifestation of CHIKV infection mimics DENV infection in these areas and it has been postulated that many CHIKV infections are misdiagnosed as DENV, thus causing CHIKV infections to be under reported. The widespread emergence of DENV and exponential increase in CHIK cases in Karnataka state warrants the need for more effective surveillance to monitor the spread of these deadly arboviruses so that timely control strategies can be implemented.

 
 ~ References Top

1.
Nayar SK, Noridah O, Paranthaman V, Ranjit K, Norizah I, Chem YK. Coinfection of dengue virus and chikungunya virus in two patients with acute febrile illness. Med J Malaysia 2007;62:335-6.  Back to cited text no. 1
    
2.
Myers RM, Carey DE. Concurrent isolation from patient of two arboviruses, Chikungunya and dengue type 2. Science 1967;157:1307-8.  Back to cited text no. 2
[PUBMED]    
3.
Halstead SB, Nimmannitya S, Margiotta MR. Dengue and chikungunya virus infections in man in Thailand, 1962-1964. II. Observations on disease in outpatients. Am J Trop Med Hyg 1967;18:972-83.  Back to cited text no. 3
    
4.
Chahar HS, Bharaj P, Dar L, Guleria R, Kabra SK, Broor S. Co-infections with chikungunya virus and dengue virus in Delhi, India. Emerg Infect Dis 2009;15:1077-80.  Back to cited text no. 4
    
5.
Taraphdar D, Sarkar A, Mukhopadhyay BB, Chatterjee S. A comparative study of clinical features between monotypic and dual infection cases with Chikungunya virus and dengue virus in West Bengal, India. Am J Trop Med Hyg 2012;86:720-3.  Back to cited text no. 5
    
6.
Gadkari DA, Shaikh BH. IgM antibody capture ELISA in the diagnosis of Japanese encephalitis, West Nile and dengue virus infections. Indian J Med Res 1984;80:613-9.  Back to cited text no. 6
    
7.
Satish N, Manayani DJ, Shankar V, Abraham M, Nithyanandam G, Sridharan G. Comparison of IgM capture ELISA with a commercial rapid immunochromatographic card test and IgM micro well ELISA for the detection of antibodies to dengue viruses. Indian J Med Res 2002;115:31-6.  Back to cited text no. 7
    
8.
Hapuarachchi HA, Bandara KB, Hapugoda MD, Williams S, Abeyewickreme W. Laboratory confirmation of dengue and chikungunya co-infection. Ceylon Med J 2008;53:104-5.  Back to cited text no. 8
    



 
 
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