Volume 6, Number 1—February 2000
Isolation of a Dengue Type 1 Virus from a Soldier in West Africa (Côte d'Ivoire)
To the Editor: In Africa, recent reports of epidemic or endemic dengue activity usually come from the eastern part of the continent (1), and the serotype most frequently identified is dengue 2.
We report the isolation of a dengue 1 virus strain from the blood of a young soldier living in Abidjan, the capital of Côte d'Ivoire. This 20-year-old man arrived from France on October 19, 1998. On December 28, 1998, he consulted a physician of his regiment because of headache, diarrhea, and fever (40°C). The results of the laboratory investigations were as follows: platelets (193 109 /L), leukocytes (2.2109 /L); no malaria was found. He was hospitalized for possible arboviral infection, and treatment with paracetamol was prescribed. On December 29, a blood sample was collected; serum and buffy coat were frozen at -20°C for further examination at the Institute of Tropical Medicine of the Military Health Services. On day 3, the patient's temperature dropped to 38°C, then rose to 39.5°C on day 5. All symptoms were resolved on day 6.
On February 15, 1999, the frozen blood was defrosted and the lysed buffy coat was immediately cocultured with C6/36 cells. On day 6, a blind passage was made on the same cells and on Vero. On day 12, no cytopathic effect was observed, but a dengue 1 virus was identified by indirect fluorescent antibody assay (2) with type-specific monoclonal antibodies. This diagnosis was confirmed by reverse transcription-polymerase chain reaction, with a technique slightly modified from Lanciotti (3).
On the first blood specimen, the serologic immunoglobulin (Ig)M assays (M antibody capture enzyme-linked immunosorbent assay [ELISA]) with our antigen screening panel were negative (dengue, West Nile, Chikungunya, Rift Valley fever). The IgG assay (ELISA) against dengue antigen was also negative.
The patient returned to France in February 1999. A second blood sample was collected and tested on April 7, 1999, 3 months after the illness. The serologic assays were positive against the dengue antigens at the following dilutions of the serum: IgM: dengue 1: 1/120,000; dengue 2: 1/40,000; dengue 3: 1/12,000; dengue 4: 1/25,000. IgG: dengue 1: 1/75,000; dengue 2: 1/90,000; dengue 3: 1/60,000; dengue 4: 1/120,000. This seroconversion allowed us to confirm infection of this patient by a dengue virus.
The lack of similar reported cases or epidemics among the local and expatriate populations of Abidjan may indicate poor transmission, recent introduction of the strain, or low virulence of the virus, as previously hypothesized for dengue in West Africa (4). However, the serologic status of the human population needs to be further investigated. Characterization of the isolated viral strain would be of interest for dengue epidemiology. Complete sequencing of the viral RNA is in progress in our laboratory.
Human infection with dengue virus has been rarely reported and studied in West Africa, and the epidemiology of serotype 1 is poorly documented. During the past 35 years, the Pasteur Institute of Dakar confirmed three dengue 1 strains (two from humans in Senegal; one from mosquitoes in Côte d'Ivoire), while during the same period, more than 300 dengue 2 strains were studied, most from mosquitoes (5). In the past 10 years, medical and entomologic surveys showed circulation of dengue 2 virus in Senegal (one isolate in the blood of a French soldier) (6). However, during the 1970s, Nigerian virologists demonstrated circulation of dengue 1 and 2 in their country: more than 50% of the adults living in the savannah had neutralizing antibodies (7). Of 148 blood samples of febrile patients, three viral strains (yellow fever, dengue 1, and Zika) were isolated, all from children (8).
In Africa, outside the epidemics of yellow fever, it is difficult to isolate arboviruses from adult humans. Isolation is often more successful from children or naive expatriates. Accordingly, soldiers participating in international operations constitute a very exposed population. During recent operations in Somalia (1992-93), dengue fever was an important cause of febrile illness among U.S. troops (9). Thirty-nine dengue 2 and three dengue 3 strains were isolated from 96 collected sera.
We thank F. Tock and S. Guesdon for technical assistance and D. Gubler and N. Karabatsos for the monoclonal antibodies used for virus typing.
This work was supported by the Délégation Générale à L'Armement.
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