title: Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua.
abstract: BACKGROUND
  Dengue is an emerging infectious disease of global significance. Suspected dengue, especially in children in Nicaragua's heavily-urbanized capital of Managua, has been well documented, but unsuspected dengue among children and adults with undifferentitated fever has not.
  
  
  RESULTS
  To prospectively study dengue in semi-urban and rural western Nicaragua, we obtained epidemiologic and clinical data as well as acute and convalescent sera (2 to 4 weeks after onset of illness) from a convenience sample (enrollment Monday to Saturday daytime to early evening) of consecutively enrolled patients (n = 740) aged ≥ 1 years presenting with acute febrile illness. We tested paired sera for dengue IgG and IgM and serotyped dengue virus using reverse transcriptase-PCR. Among 740 febrile patients enrolled, 90% had paired sera. We found 470 (63.5%) were seropositive for dengue at enrollment. The dengue seroprevalance increased with age and reached >90% in people over the age of 20 years. We identified acute dengue (serotypes 1 and 2) in 38 (5.1%) patients. Only 8.1% (3/37) of confirmed cases were suspected clinically.
  
  
  CONCLUSIONS
  Dengue is an important and largely unrecognized cause of fever in rural western Nicaragua. Since Zika virus is transmitted by the same vector and has been associated with severe congenital infections, the population we studied is at particular risk for being devastated by the Zika epidemic that has now reached Central America.
authors: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.
authors: Megan E
authors: ME
authors: Reller
authors: Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
authors: Aravinda M
authors: AM
authors: de Silva
authors: Duke University School of Medicine, Durham, North Carolina, United States of America.
authors: Jeremy J
authors: JJ
authors: Miles
authors: Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
authors: Ramesh S
authors: RS
authors: Jadi
authors: Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
authors: Anne
authors: A
authors: Broadwater
authors: Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America.
authors: Katie
authors: K
authors: Walker
authors: Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.|Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.
authors: Christopher
authors: C
authors: Woods
authors: Hospital Escuela Oscar Danilo Rosales Arguello, Universidad Nacional Autonoma de Nicaragua, León, Nicaragua.
authors: Orlando
authors: O
authors: Mayorga
authors: Hospital Escuela Oscar Danilo Rosales Arguello, Universidad Nacional Autonoma de Nicaragua, León, Nicaragua.
authors: Armando
authors: A
authors: Matute
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D003716:Dengue Virus / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral