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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Infectious Diseases 1/2018

Co-circulation and simultaneous co-infection of dengue, chikungunya, and zika viruses in patients with febrile syndrome at the Colombian-Venezuelan border

BMC Infectious Diseases > Ausgabe 1/2018
Marlen Yelitza Carrillo-Hernández, Julian Ruiz-Saenz, Lucy Jaimes Villamizar, Sergio Yebrail Gómez-Rangel, Marlen Martínez-Gutierrez
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12879-018-2976-1) contains supplementary material, which is available to authorized users.



In Colombia, the dengue virus (DENV) has been endemic for decades, and with the recent entry of the chikungunya virus (CHIKV) (2014) and the Zika virus (ZIKV) (2015), health systems are overloaded because the diagnosis of these three diseases is based on clinical symptoms, and the three diseases share a symptomatology of febrile syndrome. Thus, the objective of this study was to use molecular methods to identify their co-circulation as well as the prevalence of co-infections, in a cohort of patients at the Colombian-Venezuelan border.


A total of 157 serum samples from patients with febrile syndrome consistent with DENV were collected after informed consent and processed for the identification of DENV (conventional PCR and real-time PCR), CHIKV (conventional PCR), and ZIKV (real-time PCR). DENV-positive samples were serotyped, and some of those positive for DENV and CHIKV were sequenced.


Eighty-two patients were positive for one or more viruses: 33 (21.02%) for DENV, 47 (29.94%) for CHIKV, and 29 (18.47%) for ZIKV. The mean age range of the infected population was statistically higher in the patients infected with ZIKV (29.72 years) than in those infected with DENV or CHIKV (21.09 years). Both co-circulation and co-infection of these three viruses was found. The prevalence of DENV/CHIKV, DENV/ZIKV, and CHIKV/ZIKV co-infection was 7.64%, 6.37%, and 5.10%, with attack rates of 14.90, 12.42, and 9.93 cases per 100,000 inhabitants, respectively. Furthermore, three patients were found to be co-infected with all three viruses (prevalence of 1.91%), with an attack rate of 4.96 cases per 100,000 inhabitants.


Our results demonstrate the simultaneous co-circulation of DENV, CHIKV, ZIKV and their co-infections at the Colombian-Venezuelan border. Moreover, it is necessary to improve the differential diagnosis in patients with acute febrile syndrome and to study the possible consequences of this epidemiological overview of the clinical outcomes of these diseases in endemic regions.
Additional file 1: Figure S1. Phylogenetic analysis of DENV-1 circulating strain in Villa del Rosario (2015). The evolutionary history was deduced by using the Neighbor-Joining protocol for gene pr-M protein, using a fragment of 431 nucleotides. (DOCX 313 kb)
Additional file 2: Figure S2. Phylogenetic analysis of the DENV-2 circulating strain in Villa del Rosario. The evolutionary history was deduced by using the Neighbor-Joining protocol for gene pr-M protein, using a fragment of 429 nucleotides. (DOCX 414 kb)
Additional file 3: Figure S3. Phylogenetic analysis of DENV-3 strains isolated in Villa del Rosario. The evolutionary history was deduced by using the Neighbor-Joining protocol for gene pr-M protein, using a fragment of 430 nucleotides. (DOCX 392 kb)
Additional file 4: Figure S4. Phylogenetic analysis of CHIKV strains circulating in Villa del Rosario. The evolutionary history was deduced using the Neighbor-Joining protocol for Env protein gene, using a fragment of 326 nucleotides. (DOCX 418 kb)
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