title: Clinical and virological descriptive study in the 2011 outbreak of dengue in the Amazonas, Brazil.
abstract: BACKGROUND
  Dengue is a vector-borne disease in the tropical and subtropical region of the world and is transmitted by the mosquito Aedes aegypti. In the state of Amazonas, Brazil during the 2011 outbreak of dengue all the four Dengue virus (DENV) serotypes circulating simultaneously were observed. The aim of the study was to describe the clinical epidemiology of dengue in Manaus, the capital city of the state of the Amazonas, where all the four DENV serotypes were co-circulating simultaneously.
  
  
  METHODS
  Patients with acute febrile illness during the 2011 outbreak of dengue, enrolled at the Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), a referral centre for tropical and infectious diseases in Manaus, were invited to participate in a clinical and virological descriptive study. Sera from 677 patients were analyzed by RT-nested-PCRs for flaviviruses (DENV 1-4, Saint Louis encephalitis virus-SLEV, Bussuquara virus-BSQV and Ilheus virus-ILHV), alphavirus (Mayaro virus-MAYV) and orthobunyavirus (Oropouche virus-OROV).
  
  
  RESULTS
  Only dengue viruses were detected in 260 patients (38.4%). Thirteen patients were co-infected with more than one DENV serotype and six (46.1%) of them had a more severe clinical presentation of the disease. Nucleotide sequencing showed that DENV-1 belonged to genotype V, DENV-2 to the Asian/American genotype, DENV-3 to genotype III and DENV-4 to genotype II.
  
  
  CONCLUSIONS
  Co-infection with more than one DENV serotype was observed. This finding should be warning signs to health authorities in situations of the large dispersal of serotypes that are occurring in the world.
authors: Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil.
authors: Valquiria do Carmo Alves
authors: Vdo C
authors: Martins
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil.
authors: Michele de Souza
authors: Mde S
authors: Bastos
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil; Universidade Nilton Lins, Manaus, Amazonas, Brazil.
authors: Rajendranath
authors: R
authors: Ramasawmy
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil.
authors: Regina Pinto
authors: RP
authors: de Figueiredo
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil.
authors: João Bosco Lima
authors: JB
authors: Gimaque
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil.
authors: Wornei Silva Miranda
authors: WS
authors: Braga
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Faculdade de Medicina de São Jose do Rio Preto (FAMERP), São Jose do Rio Preto, São Paulo, Brazil.
authors: Mauricio Lacerda
authors: ML
authors: Nogueira
authors: Universidade Nilton Lins, Manaus, Amazonas, Brazil.
authors: Sergio
authors: S
authors: Nozawa
authors: Instituto Leônidas & Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, Amazonas, Brazil.
authors: Felipe Gomes
authors: FG
authors: Naveca
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Centro de Pesquisas em Virologia, Faculdade de Medicina de Ribeirão Preto (FMRP-USP), Ribeirão Preto, São Paulo, Brazil.
authors: Luiz Tadeu Moraes
authors: LT
authors: Figueiredo
authors: Fundação de Medicina Tropical Dr. Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil; Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil; Universidade Nilton Lins, Manaus, Amazonas, Brazil.
authors: Maria Paula Gomes
authors: MP
authors: Mourão
mesh_terms: D000293:Adolescent; D000328:Adult; D000330:Aedes / Q000821:virology; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001483:Base Sequence; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology* / Q000503:physiopathology / Q000635:transmission / Q000821:virology; D003716:Dengue Virus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D004196:Disease Outbreaks; D004199:Disease Vectors; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012703:Serotyping; D012720:Severity of Illness Index
chemical_list: D012367:RNA, Viral