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Chikungunya Virus Infections Among Patients with Dengue-Like Illness at a Tertiary Care Hospital in the Philippines, 2012–2013

John Mark VelascoDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Maria Theresa ValderamaDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Maria Nila LopezDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Domingo Chua Jr.Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Rene Latog IIDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Vito Roque Jr.Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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June CorpuzDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Chonticha KlungthongDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Prinyada RodpraditDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Kittinun HussemDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Yongyuth PoolpanichupatamDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Louis MacareoDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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Stefan FernandezDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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In-Kyu YoonDepartment of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Armed Forces of the Philippines Medical Service School, Quezon City, Philippines; Department of Research and Training, Armed Forces of the Philippines Medical Center, Quezon City, Philippines; Epidemiology Bureau, Department of Health, Manila, Philippines

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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.

Author Notes

* Address correspondence to John Mark Velasco, Department of Virology, Armed Forces Research Institute of Medical Sciences, 315/6, Rajvithi Road, Bangkok 10400, Thailand. E-mail: velascojm@afrims.org

Financial support: This study was funded by the U.S. Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response Systems (AFHSC-GEIS).

Authors' addresses: John Mark Velasco and Maria Theresa Valderama, Philippines-AFRIMS Virology Research Unit, V. Luna General Hospital, Armed Forces of the Philippines Medical Center, Quezon City, Philippines, E-mails: john.velasco.ca@afrims.org and valderamamg.ca@afrims.org. Maria Nila Lopez, Armed Forces of the Philippines Medical Service School, Quezon City, Philippines, E-mail: manila28@yahoo.com.ph. Domingo Chua Jr. and Rene Latog II, Department of Research and Training, V. Luna General Hospital, Armed Forces of the Philippines Medical Center, Quezon City, Philippines, E-mails: dachuajr@gmail.com and latogreneii@yahoo.com. Vito Roque Jr. and June Corpuz, Epidemiology Bureau, Department of Health, Manila, Philippines, E-mails: vitogroquejr@gmail.com and jcbcorpuz@gmail.com. Chonticha Klungthong, Prinyada Rodpradit, Kittinun Hussem, Yongyuth Poolpanichupatam, Louis Macareo, Stefan Fernandez, and In-Kyu Yoon, Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, E-mails: chontichak.fsn@afrims.org, prinyadar.ca@afrims.org, kittinunh.fsn@afrims.org, yongyuthp.fsn@afrims.org, louis.macareo.mil@afrims.org, stefan.fernandez.mil@afrims.org, and inkyu.yoon.mil@afrims.org.

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