title: Concurrent infections of dengue viruses serotype 2 and 3 in patient with severe dengue from Jakarta, Indonesia.
abstract: OBJECTIVE
  To describe the clinical manifestation of patient with severe dengue, to identify the serotypes and genotypes of dengue viruses (DENV) which concurrently infecting the patient, and to explore the possible relationship of severe dengue with the concurrent infection of DENV.
  
  
  METHODS
  Dengue diagnosis was performed using NS1 antigen detection and IgG/IgM ELISA. Standard clinical and laboratory examinations were performed to obtain the clinical and hematological data. DENV concurrent infections were detected and confirmed using RT-PCR and DENV Envelope gene sequencing. Phylogenetic analyses were performed to determine the genotypes of the viruses.
  
  
  RESULTS
  The patient was classified as having severe dengue characterized by severe plasma leakage, hemorrhage, and organ damage involving lung, liver, and kidney. Concurrent infection of DENV serotype 2 and 3 was observed. The infecting DENV-2 virus was grouped into Cosmopolitan genotype while DENV-3 virus was classified into Genotype I. Both viruses were closely related to isolates that were endemic in Jakarta. Viremia measurement was conducted and revealed a significantly higher virus titer of DENV-3 compared to DENV-2.
  
  
  CONCLUSIONS
  The occurrence of multi-serotype DENV infections was presented in a patient with severe clinical manifestation in Indonesia. The hyperendemicity of dengue in Indonesia may contribute to the DENV concurrent infections cases and may underlie the severity of the disease.
authors.affiliation: Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia.
authors.forename: Soroy
authors.initials: S
authors.lastname: Lardo
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Yaldiera
authors.initials: Y
authors.lastname: Utami
authors.affiliation: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors.forename: Benediktus
authors.initials: B
authors.lastname: Yohan
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Seri Mmu
authors.initials: SM
authors.lastname: Tarigan
authors.affiliation: Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia.
authors.forename: Widayat Djoko
authors.initials: WD
authors.lastname: Santoso
authors.affiliation: Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Nainggolan
authors.affiliation: Eijkman Institute for Molecular Biology, Jakarta, Indonesia. Electronic address: sasmono@eijkman.go.id.
authors.forename: R Tedjo
authors.initials: RT
authors.lastname: Sasmono
keywords: Concurrent infections; DENV-2; DENV-3; Severe dengue