Volume 93, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Chikungunya virus (CHIKV) often co-circulates with dengue virus (DENV). A cross-sectional surveillance study was conducted at a tertiary hospital in Manila, Philippines, to describe the prevalence and characteristics of DENV and CHIKV infections among patients seeking care for dengue-like illness. Acute blood samples from patients ≥ 6 months of age clinically diagnosed with dengue from November 2012 to December 2013 underwent reverse transcription polymerase chain reaction (RT-PCR) to detect DENV and CHIKV RNA. A total of 118 patients with clinically diagnosed dengue (age range = 1–89 years, mean = 22 years; male-to-female ratio = 1.51) were tested by DENV RT-PCR; 40 (34%) were DENV PCR-positive (age range = 1–45 years, mean = 17 years). All DENV serotypes were detected: 11 (28%) DENV-1, 6 (15%) DENV-2, 6 (15%) DENV-3, and 17 (42%) DENV-4. Of 112 patients clinically diagnosed with dengue and tested by CHIKV RT-PCR, 11 (10%) were CHIKV PCR-positive (age range = 2–47 years, mean = 20.3 years). No coinfections were detected. Presenting signs/symptoms did not differ between DENV- and CHIKV-positive cases. Sequencing of envelope 1 gene from two CHIKV PCR-positive samples showed Asian genotype. This study highlights the potential for misdiagnosis of medically attended CHIKV infections as DENV infection and the difficulty in clinically differentiating dengue and chikungunya based on presenting signs/symptoms alone. This underscores the necessity for diagnostic laboratory tests to distinguish CHIKV infections in the background of actively co-circulating DENV.


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  1. Strauss JH, Strauss EG, , 1994. The alphaviruses: gene expression, replication, and evolution. Microbiol Rev 58: 491562. [Google Scholar]
  2. Robinson MC, , 1955. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952–53. I. Clinical features. Trans R Soc Trop Med Hyg 49: 2832.[Crossref] [Google Scholar]
  3. Hammon WM, Rudnick A, Sather GE, , 1960. Viruses associated with epidemic hemorrhagic fevers of the Philippines and Thailand. Science 131: 11021103.[Crossref] [Google Scholar]
  4. Thiberville SD, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, de Lamballerie X, , 2013. Chikungunya fever: epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res 99: 345370.[Crossref] [Google Scholar]
  5. Staples JE, Breiman RF, Powers AM, , 2009. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis 49: 942948.[Crossref] [Google Scholar]
  6. Borgherini G, Poubeau P, Jossaume A, Gouix A, Cotte L, Michault A, Arvin-Berod C, Paganin F, , 2008. Persistent arthralgia associated with chikungunya virus: a study of 88 adult patients on Reunion Island. Clin Infect Dis 47: 469475.[Crossref] [Google Scholar]
  7. Larrieu S, Pouderoux N, Pistone T, Filleul L, Receveur MC, Sissoko D, Ezzedine K, Malvy D, , 2010. Factors associated with persistence of arthralgia among chikungunya virus-infected travellers: report of 42 French cases. J Clin Virol 47: 8588.[Crossref] [Google Scholar]
  8. Pulmanausahakul R, Roytrakul S, Auewarakul P, Smith DR, , 2011. Chikungunya in southeast Asia: understanding the emergence and finding solutions. Int J Infect Dis 15: e671e676.[Crossref] [Google Scholar]
  9. Powers AM, Logue CH, , 2007. Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus. J Gen Virol 88: 23632377.[Crossref] [Google Scholar]
  10. Renault P, Solet JL, Sissoko D, Balleydier E, Larrieu S, Filleul L, Lassalle C, Thiria J, Rachou E, de Valk H, Ilef D, Ledrans M, Quatresous I, Quenel P, Pierre V, , 2007. A major epidemic of chikungunya virus infection on Reunion Island, France, 2005–2006. Am J Trop Med Hyg 77: 727731. [Google Scholar]
  11. Ramful D, Carbonnier M, Pasquet M, Bouhmani B, Ghazouani J, Noormahomed T, Beullier G, Attali T, Samperiz S, Fourmaintraux A, Alessandri JL, , 2007. Mother-to-child transmission of chikungunya virus infection. Pediatr Infect Dis J 26: 811815.[Crossref] [Google Scholar]
  12. Lanciotti RS, Valadere AM, , 2014. Transcontinental movement of Asian genotype chikungunya virus. Emerg Infect Dis 20: 14001402.[Crossref] [Google Scholar]
  13. Omarjee R, Prat C, Flusin O, Boucau S, Tenebray B, Merle O, Huc-Anais P, Cassadou S, Leparc-Goffart I, , 2014. Importance of case definition to monitor ongoing outbreak of chikungunya virus on a background of actively circulating dengue virus, St. Martin, December 2013 to January 2014. Euro Surveill 19: pii: 20753.[Crossref] [Google Scholar]
  14. Roth A, Mercier A, Lepers C, Hoy D, Duituturaga S, Benyon E, Guillaumot L, Souares Y, , 2014. Concurrent outbreaks of dengue, chikungunya and Zika virus infections—an unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012. Euro Surveill 19: pii: 20929.[Crossref] [Google Scholar]
  15. Lertanekawattana S, Anantapreecha S, Jiraphongsa C, Duan-ngern P, Potjalongsin S, Wiittayabamrung W, Daroon P, Techolarn M, , 2013. Prevalence and characteristics of dengue and chikungunya infections among acute febrile patients in Nong Khai Province, Thailand. Southeast Asian J Trop Med Public Health 44: 780790. [Google Scholar]
  16. Rezza G, El-Sawaf G, Faggioni G, Vescio F, Al Ameri R, De Santis R, Helaly G, Pomponi A, Metwally D, Fantini M, Qadi H, Ciccozzi M, Lista F, , 2014. Co-circulation of dengue and chikungunya viruses, Al Hudaydah, Yemen, 2012. Emerg Infect Dis 20: 13511354.[Crossref] [Google Scholar]
  17. Laoprasopwattana K, Kaewjungwad L, Jarumanokul R, Geater A, , 2012. Differential diagnosis of chikungunya, dengue viral infection and other acute febrile illnesses in children. Pediatr Infect Dis J 31: 459463.[Crossref] [Google Scholar]
  18. Nimmannitya S, Halstead SB, Cohen SN, Margiotta MR, , 1969. Dengue and chikungunya virus infection in man in Thailand, 1962–1964. I. Observations on hospitalized patients with hemorrhagic fever. Am J Trop Med Hyg 18: 954971. [Google Scholar]
  19. Campos LE, San Juan A, Cenabre LC, Almagro EF, , 1969. Isolation of chikungunya virus in the Philippines. Acta Med Philipp 5: 152155. [Google Scholar]
  20. Gutierrez-Rubio A, Magbitang A, Penserga E, , 2014. A three-month follow up of musculoskeletal manifestations in chikungunya fever. Philippine J Int Med 52: 15. [Google Scholar]
  21. Retuya T, Ting D, Dacula B, , 1998. Chikungunya fever outbreak in an agricultural village in Indang, Cavite, Philippines. Philipp J Microbiol Infect Dis 27: 9396. [Google Scholar]
  22. Macasaet FF, , 1970. Further observation on chikungunya fever. J Philippines Med Assoc 46: 235242. [Google Scholar]
  23. Hayes CG, O'Rourke TF, Sarr A, , 1986. Chikungunya fever among U.S. Peace Corps volunteers—Republic of the Philippines. MMWR 35: 573574. [Google Scholar]
  24. Tesh RB, Gajdusek DC, Garruto RM, Cross JH, Rosen L, , 1975. The distribution and prevalence of group A arbovirus neutralizing antibodies among human populations in southeast Asia and the Pacific islands. Am J Trop Med Hyg 24: 664675. [Google Scholar]
  25. Capeding MR, Chua MN, Hadinegoro SR, Hussain II, Nallusamy R, Pitisuttithum P, Rusmil K, Thisyakorn U, Thomas SJ, Huu Tran N, Wirawan DN, Yoon IK, Bouckenooghe A, Hutagalung Y, Laot T, Wartel TA, , 2013. Dengue and other common causes of acute febrile illness in Asia: an active surveillance study in children. PLoS Negl Trop Dis 7: e2331.[Crossref] [Google Scholar]
  26. Yoon IK, Alera MT, Lago CB, Tac-An IA, Villa D, Fernandez S, Thaisomboonsuk B, Klungthong C, Levy JW, Velasco JM, Roque VG, Jr Salje H, Macareo LR, Hermann LL, Nisalak A, Srikiatkhachorn A, , 2015. High rate of subclinical chikungunya virus infection and association of neutralizing antibody with protection in a prospective cohort in the Philippines. PLoS Negl Trop Dis 9: e0003764.[Crossref] [Google Scholar]
  27. Bhatia R, Narain JP, , 2009. Re-emerging chikungunya fever: some lessons from Asia. Trop Med Int Health 14: 940946.[Crossref] [Google Scholar]
  28. WHO, 2009. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: WHO Press. [Google Scholar]
  29. Porter KR, Tan R, Istary Y, Suharyono W, Sutaryo Widjaja S, Ma'Roef C, Listiyaningsih E, Kosasih H, Hueston L, McArdle J, Juffrie M, , 2004. A serological study of Chikungunya virus transmission in Yogyakarta, Indonesia: evidence for the first outbreak since 1982. Southeast Asian J Trop Med Public Health 35: 408415. [Google Scholar]
  30. Laras K, Sukri NC, Larasati RP, Bangs MJ, Kosim R, Djauzi Wandra T, Master J, Kosasih H, Hartati S, Beckett C, Sedyaningsih ER, Beecham HJ, 3rd Corwin AL, , 2005. Tracking the re-emergence of epidemic chikungunya virus in Indonesia. Trans R Soc Trop Med Hyg 99: 128141.[Crossref] [Google Scholar]
  31. Klungthong C, Gibbons RV, Thaisomboonsuk B, Nisalak A, Kalayanarooj S, Thirawuth V, Nutkumhang N, Mammen MP, Jr Jarman RG, , 2007. Dengue virus detection using whole blood for reverse transcriptase PCR and virus isolation. J Clin Microbiol 45: 24802485.[Crossref] [Google Scholar]
  32. Kularatne SA, Gihan MC, Weerasinghe SC, Gunasena S, , 2009. Concurrent outbreaks of chikungunya and dengue fever in Kandy, Sri Lanka, 2006–07: a comparative analysis of clinical and laboratory features. Postgrad Med J 85: 342346.[Crossref] [Google Scholar]
  33. Nkoghe D, Kassa RF, Bisvigou U, Caron M, Grard G, Leroy EM, , 2012. No clinical or biological difference between chikungunya and dengue fever during the 2010 Gabonese outbreak. Infect Dis Rep 4: e5.[Crossref] [Google Scholar]
  34. Tomasello D, Schlagenhauf P, , 2013. Chikungunya and dengue autochthonous cases in Europe, 2007–2012. Travel Med Infect Dis 11: 274284.[Crossref] [Google Scholar]
  35. Ratsitorahina M, Harisoa J, Ratovonjato J, Biacabe S, Reynes JM, Zeller H, Raoelina Y, Talarmin A, Richard V, Louis Soares J, , 2008. Outbreak of dengue and chikungunya fevers, Toamasina, Madagascar, 2006. Emerg Infect Dis 14: 11351137.[Crossref] [Google Scholar]
  36. Leroy EM, Nkoghe D, Ollomo B, Nze-Nkogue C, Becquart P, Grard G, Pourrut X, Charrel R, Moureau G, Ndjoyi-Mbiguino A, De-Lamballerie X, , 2009. Concurrent chikungunya and dengue virus infections during simultaneous outbreaks, Gabon, 2007. Emerg Infect Dis 15: 591593.[Crossref] [Google Scholar]
  37. Chipwaza B, Mugasa JP, Selemani M, Amuri M, Mosha F, Ngatunga SD, Gwakisa PS, , 2014. Dengue and chikungunya fever among viral diseases in outpatient febrile children in Kilosa District Hospital, Tanzania. PLoS Negl Trop Dis 8: e3335.[Crossref] [Google Scholar]
  38. Lee VJ, Chow A, Zheng X, Carrasco LR, Cook AR, Lye DC, Ng LC, Leo YS, , 2012. Simple clinical and laboratory predictors of chikungunya versus dengue infections in adults. PLoS Negl Trop Dis 6: e1786.[Crossref] [Google Scholar]
  39. Taraphdar D, Sarkar A, Mukhopadhyay BB, Chatterjee S, , 2012. A comparative study of clinical features between monotypic and dual infection cases with chikungunya virus and dengue virus in West Bengal, India. Am J Trop Med Hyg 86: 720723.[Crossref] [Google Scholar]
  40. Mackenzie JS, Chua KB, Daniels PW, Eaton BT, Field HE, Hall RA, Halpin K, Johansen CA, Kirkland PD, Lam SK, McMinn P, Nisbet DJ, Paru R, Pyke AT, Ritchie SA, Siba P, Smith DW, Smith GA, van den Hurk AF, Wang LF, Williams DT, , 2001. Emerging viral diseases of southeast Asia and the Western Pacific. Emerg Infect Dis 7: 497504.[Crossref] [Google Scholar]
  41. Sissoko D, Ezzedine K, Moendandze A, Giry C, Renault P, Malvy D, , 2005–2006. Field evaluation of clinical features during chikungunya outbreak in Mayotte. Trop Med Int Health 15: 600607. [Google Scholar]
  42. Nkoghe D, Kassa RF, Caron M, Grard G, Mombo I, Bikie B, Paupy C, Becquart P, Bisvigou U, Leroy EM, , 2012. Clinical forms of chikungunya in Gabon, 2010. PLoS Negl Trop Dis 6: e1517.[Crossref] [Google Scholar]
  43. Jupp PG, McIntosh BM, Monath TP, , 1988. Chikungunya virus disease. , ed. The Arbovirus: Epidemiology and Ecology. Boca Raton, FL: CRC Press, 137157. [Google Scholar]
  44. Chusri S, Siripaitoon P, Silpapojakul K, Hortiwakul T, Charernmak B, Chinnawirotpisan P, Nisalak A, Thaisomboonsuk B, Klungthong C, Gibbons RV, Jarman RG, , 2014. Kinetics of chikungunya infections during an outbreak in southern Thailand, 2008–2009. Am J Trop Med Hyg 90: 410417.[Crossref] [Google Scholar]
  45. Pialoux G, Gauzere BA, Jaureguiberry S, Strobel M, , 2007. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 7: 319327.[Crossref] [Google Scholar]
  46. Boelle PY, Thomas G, Vergu E, Renault P, Valleron AJ, Flahault A, , 2008. Investigating transmission in a two-wave epidemic of chikungunya fever, Reunion Island. Vector Borne Zoonotic Dis 8: 207217.[Crossref] [Google Scholar]
  47. Macasaet F, Nakao J, Rustia F, Beran G, Buscato N, , 1969. Epidemiology of arbovirus infections in Negros Oriental: I. Clinical features of an epidemic in Amlan. J Philipp Med Assoc 45: 207215. [Google Scholar]

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  • Received : 05 May 2015
  • Accepted : 08 Aug 2015
  • Published online : 09 Dec 2015

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