Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil.
Recherches translationelles sur le virus de l'immunodéficience et les maladies infectieuses, Institut de Recherche pour le Développement, University of Montpellier, Institut national de la santé et de la recherche médicale, France.
Clin Infect Dis. 2019 Feb 15;68(5):810-817. doi: 10.1093/cid/ciy630.
Seasonal outbreaks of dengue often result in hundreds of dengue-suspected cases where a clinical diagnosis cannot be confirmed. Usually, during large outbreaks of dengue and other pathogens that can cause acute febrile illnesses, the search for secondary pathogens with similar disease outcomes is rare.
Using total RNA sequencing and targeted diagnostic assays, we discovered an outbreak of parvovirus B19 in dengue-suspected patients that occurred from November 2013 to February 2014.
Of the 182 cases investigated, 63% were viremic for the B19 virus. Moreover, we found that >43% of infected patients had no serological evidence of prior infection. Parvovirus B19 is a typical childhood infection, yet we observed that 82% of the infected patients were adults. Additionally, we perceived that infected adults had significantly higher presentations of myalgia than in children. We also obtained viral protein (VP) 1/VP2 gene nucleotide sequences from 43 patients.
Our results support the utility of next-generation sequencing for symptomatic patients with unknown etiologies during seasonal outbreaks of dengue and other arborviruses. Our findings could improve the vigilance of hospitals and laboratories by raising awareness of co-circulating pathogens such as parvovirus B19 that may be hidden in plain sight.
登革热季节性暴发常导致数百例疑似登革热病例，而这些病例无法通过临床诊断来确诊。通常，在登革热和其他可引起急性发热疾病的病原体大暴发期间，很少会寻找具有类似疾病结果的继发性病原体。
我们使用全 RNA 测序和靶向诊断检测方法，发现了 2013 年 11 月至 2014 年 2 月期间发生在疑似登革热患者中的细小病毒 B19 暴发。
在所调查的 182 例病例中，63%为细小病毒 B19 血症。此外，我们发现>43%的感染患者没有先前感染的血清学证据。细小病毒 B19 是一种典型的儿童感染，但我们观察到 82%的感染患者为成年人。此外，我们认为感染的成年人肌肉疼痛的表现明显高于儿童。我们还从 43 名患者中获得了病毒蛋白（VP）1/VP2 基因核苷酸序列。
我们的研究结果支持在季节性登革热和其他虫媒病毒暴发期间，对病因不明的有症状患者使用下一代测序。我们的发现可以提高医院和实验室的警惕性，使人们意识到细小病毒 B19 等可能隐藏在明处的循环病原体。
