Time course of concurrent infection with dengue virus serotypes 2 and 4 detected in urine

Abstract

Abstract Background In hyperendemic areas, concurrent multiserotype dengue virus (DENV) infections commonly occur in both humans and in mosquito vectors. Previous studies have focused on single blood specimens. Objectives To illustrate and characterize the time course of mixed infection with DENV serotypes 2 (DENV2) and 4 (DENV4) in a single case. Materials and methods Plasma, saliva, and urine were collected from a patient diagnosed with dengue hemorrhagic fever grade II and secondary DENV infection on days 7, 18, and 31 of his illness. DENV RNA detection was performed using 2 DENV-specific reverse transcriptase-polymerase chain reaction protocols. Cloning and sequencing were performed to quantify the major and minor viral populations in dual-serotype-infected specimen(s). Genotypes of both DENV serotypes were characterized. Results DENV genome was detected in plasma and saliva only at the first time point (day 7 of illness), but in urine at both the first and second time points (days 7 and 18 of illness). DENV4 serotype was found in all DENV genome-positive specimens. DENV2 serotype was unexpectedly also detected in the first urine specimen. DENV4 as the major and DENV2 as the minor population. The DENV2 serotype was clustered in genotype Asian I and DENV4 serotype in genotype I. Conclusion To our knowledge, this is the first report of concurrent multiserotype DENV infection detected solely in urine. Prospective noninvasive investigations may determine the prevalence of this phenomenon. Clinical and public health implications of this finding need to be explored.