title: Zika and Chikungunya virus co-infection in a traveller returning from Colombia, 2016: virus isolation and genetic analysis.
abstract: BACKGROUND
  Zikavirus(ZIKV) andChikungunyavirus(CHIKV) can share the same mosquito vector, and co-infections by these viruses can occur in humans. While infections with these viruses share commonalities, CHIKV is unique in causing arthritis and arthralgias that may persist for a year or more. These infections are commonly diagnosed by RT-PCR-based methods during the acute phase of infection. Even with the high specificity and sensitivity characteristic of PCR, false negatives can occur, highlighting the need for additional diagnostic methods for confirmation.
  
  
  METHODS
  On her return to the USA, a traveller to Colombia, South America developed an illness consistent with Zika, Chikungunya and/or Dengue. RT-PCR of her samples was positive only for ZIKV. However, arthralgias persisted for months, raising concerns about co-infection with CHIKV orMayaroviruses. Cell cultures inoculated with her original clinical samples demonstrated two types of cytopathic effects, and both ZIKV and CHIKV were identified in the supernatants. On phylogenetic analyses, both viruses were found to be related to strains found in Colombia.
  
  
  CONCLUSIONS
  These findings highlight the need to consider CHIKV co-infection in patients with prolonged rheumatological symptoms after diagnosis with ZIKV, and the usefulness of cell culture as an amplification step for low-viremia blood and other samples.
authors.affiliation: Division of Infectious Diseases and Global Health, Department of Medicine, College of Medicine, University of Florida , Gainesville, FL , USA.
authors.forename: Kartikeya
authors.initials: K
authors.lastname: Cherabuddi
authors.affiliation: Division of Infectious Diseases and Global Health, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Iovine
authors.affiliation: Division of Infectious Diseases and Global Health, Department of Medicine, College of Medicine, University of Florida , Gainesville, FL , USA.
authors.forename: Kairav
authors.initials: K
authors.lastname: Shah
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: White
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Taylor
authors.initials: T
authors.lastname: Paisie
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Salemi
authors.affiliation: Division of Infectious Diseases and Global Health, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
authors.forename: J Glenn
authors.initials: JG
authors.lastname: Morris
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Lednicky
keywords: Arthralgia; Chikungunya; Zika; co-infection; phylogenetic analysis; virus isolation