Volume 99, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Occurrence of Chagas disease and arbovirus coinfections is unknown, despite the vast co-endemic areas throughout the Americas. This study examined the proportion of individuals positive for and coinfections with dengue, chikungunya, and Zika viruses in Machala, Ecuador (January 2014–December 2015). Chagas seropositivity was evaluated with five commercially available assays. Dengue infections were identified by nonstructural protein 1 rapid test and enzyme linked immunosorbent assay (ELISA), immunoglobulin M ELISA, and reverse transcription PCR (RT-PCR); chikungunya and Zika infections were identified by RT-PCR. Of 658 individuals, six were positive for (0.91%), including one /dengue coinfection and one /chikungunya/dengue coinfection. The clinical manifestations of coinfected individuals corresponded to severe dengue and dengue with warning signs, respectively. We observed discrepant results by using the Hemagen Chagas kit and the rapid test Chagas Detect Plus (false positives: 3.9% and 15.4%), highlighting the need to assess diagnostic assays in geographic regions with distinct taxonomic units of


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Sommerfeld J, Kroeger A, , 2015. Innovative community-based vector control interventions for improved dengue and Chagas disease prevention in Latin America: introduction to the special issue. Trans R Soc Trop Med Hyg 109: 8588. [Google Scholar]
  2. Brenière SF, Waleckx E, Barnabé C, , 2016. Over six thousand Trypanosoma cruzi strains classified into discrete typing units (DTUs): attempt at an inventory. PLoS Negl Trop Dis 10: e0004792. [Google Scholar]
  3. Rassi A, Jr. Rassi A, Marin-Neto JA, , 2010. Chagas disease. Lancet 375: 13881402. [Google Scholar]
  4. Patterson J, Sammon M, Garg M, , 2016. Dengue, zika and chikungunya: emerging arboviruses in the new world. West J Emerg Med 17: 671. [Google Scholar]
  5. WHO, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization. [Google Scholar]
  6. Burt FJ, Rolph MS, Rulli NE, Mahalingam S, Heise MT, , 2012. Chikungunya: a re-emerging virus. Lancet 379: 662671. [Google Scholar]
  7. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR, , 2016. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med 374: 19811987. [Google Scholar]
  8. Griffiths EC, Pedersen AB, Fenton A, Petchey OL, , 2011. The nature and consequences of coinfection in humans. J Infect 63: 200206. [Google Scholar]
  9. Mangada MM, Rothman AL, , 2005. Altered cytokine responses of dengue-specific CD4+ T cells to heterologous serotypes. J Immunol 175: 26762683. [Google Scholar]
  10. Chaturvedi UC, Agarwal R, Elbishbishi EA, Mustafa AS, , 2000. Cytokine cascade in dengue hemorrhagic fever: implications for pathogenesis. FEMS Immunol Med Microbiol 28: 183188. [Google Scholar]
  11. Souza V, 2012. E-NTPDase and E-ADA activities are altered in lymphocytes of patients with indeterminate form of Chagas’ disease. Parasitol Int 61: 690696. [Google Scholar]
  12. Health in the Americas, 2017. Summary: Regional Outcome and Country Profiles. Washington, DC: PAHO/WHO. [Google Scholar]
  13. PAHO WHO, 2016. Dengue: Annual Cases Reported of Dengue, PAHO/WHO Data, Maps and Statistics. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=rdmore&cid=6290&Itemid=40734. Accessed July 18, 2017.
  14. PAHO WHO, 2017. Chikungunya: Statistic Data. Available at: http://www.paho.org/hq/index.php?option=com_topics&view=readall&cid=5927&Itemid=40931&lang=en. Accessed September 28, 2017.
  15. Mitchell C. PAHO WHO, 2016. Zika Cumulative Cases. Pan American Health Organization, World Health Organization. Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090&lang=en. Accessed February 21, 2017.
  16. Aguilar VHM, Abad-Franch F, Racines VJ, Paucar CA, , 1999. Epidemiology of Chagas disease in Ecuador. A brief review. Mem Inst Oswaldo Cruz 94: 387393. [Google Scholar]
  17. Costales JA, Jara-Palacios MA, Llewellyn MS, Messenger LA, Ocana-Mayorga S, Villacís AG, Tibayrenc M, Grijalva MJ, , 2015. Trypanosoma cruzi population dynamics in the Central Ecuadorian Coast. Acta Trop 151: 8893. [Google Scholar]
  18. Stewart-Ibarra AM, 2018. The burden of dengue fever and chikungunya in southern coastal Ecuador: epidemiology, clinical presentation, and phylogenetics from the first two years of a prospective study. Am J Trop Med Hyg 98: 14441459. [Google Scholar]
  19. Zarate-Blades CR, Bladés N, Nascimento MS, da Silveira JF, Umezawa ES, , 2007. Diagnostic performance of tests based on Trypanosoma cruzi excreted–secreted antigens in an endemic area for Chagas’ disease in Bolivia. Diagn Microbiol Infect Dis 57: 229232. [Google Scholar]
  20. Umezawa ES, Nascimento MS, Kesper N, Coura JR, Borges-Pereira J, Junqueira ACV, Camargo ME, , 1996. Immunoblot assay using excreted-secreted antigens of Trypanosoma cruzi in serodiagnosis of congenital, acute, and chronic Chagas’ disease. J Clin Microbiol 34: 21432147. [Google Scholar]
  21. Black CL, Ocaña S, Riner D, Costales JA, Lascano MS, Davila S, Arcos-Teran L, Seed JR, Grijalva MJ, , 2007. Household risk factors for Trypanosoma cruzi seropositivity in two geographic regions of Ecuador. J Parasitol 93: 1216. [Google Scholar]
  22. Abras A, Gállego M, Llovet T, Tebar S, Herrero M, Berenguer P, Ballart C, Martí C, Muñoz C, , 2016. Serological diagnosis of chronic Chagas disease: is it time for a change? J Clin Microbiol 54: 15661572. [Google Scholar]
  23. Egüez KE, Alonso-Padilla J, Terán C, Chipana Z, García W, Torrico F, Gascon J, Lozano-Beltran D-F, Pinazo M-J, , 2017. Rapid diagnostic tests duo as alternative to conventional serological assays for conclusive Chagas disease diagnosis. PLoS Negl Trop Dis 11: e0005501. [Google Scholar]

Data & Media loading...

  • Received : 24 May 2018
  • Accepted : 10 Sep 2018
  • Published online : 22 Oct 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error