![]() We performed a cross-sectional study of a convenience sample comprising 200 acute febrile patients with suspected malaria, recruited from August 2016 to February 2018 at the Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT–HVD), a reference institution for infectious diseases in the city of Manaus, the capital of Amazonas state, in the Western Brazilian Amazon. Surprisingly, we found by NGS analysis that only one out of ten analyzed pools of serum samples was positive for an arbovirus (the ZIKV) in the studied population. To test this hypothesis, we used an arbovirus DNA microarray platform and next-generation sequencing (NGS) to screen for virus infections. We hypothesized that febrile patients with a negative test for malaria might have arboviral infections. A systematic review of the literature searching for the known records of pathogens causing febrile illness in Latin America between 19 found that the etiologies of non-malaria febrile illness most frequently reported were viral infections, of which most were arboviruses. Malaria and arboviral diseases are difficult to differentiate, as patients share similar clinical features and laboratory findings. Manaus reported 8370 malaria cases in 2018. The Manaus metropolitan area is a malaria-endemic area. Manaus, the capital of Amazonas state, is the most populous city of the North Region of Brazil, with about 2.5 million inhabitants. Malaria is also endemic in the Amazon region, with a significant predominance of Plasmodium vivax (∼85%). In addition, Mayaro virus (MAYV), Rocio virus (ROCV), Saint Louis encephalitis virus (SLEV), and West Nile virus (WNV), among others, have also been reported. The most common include dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), Oropouche virus (OROV), and yellow fever virus (YFV). ![]() Over 150 arboviruses can infect humans in Brazil. The Brazilian Amazon has the highest number of arboviruses that have been detected in the world. Some of them are globalized transportation, uncontrolled urbanization, and the lack of effective vector controls. Several factors contribute to the emergence of arboviruses. Most of them are maintained in nature through a cycle of infection between vertebrates and arthropods, with humans as accidental, dead-end hosts. Arboviruses have emerged or re-emerged in increased numbers in the last 20 years. Implementation of specific viral surveillance tests will help in the early detection of viruses with epidemic potential.Īrthropod-borne viruses (arboviruses) represent a threat to global public health, especially in tropical and subtropical regions of the world. These results suggest that arboviruses are not the most frequent viral infections in patients with suspected malaria but without Plasmodium infection in the metropolitan region of Manaus. This analysis also detected the presence of primate erythroparvovirus 1 and pegivirus C. Analysis of the sequencing data revealed the presence of only one arbovirus (Zika virus) in one sample pool. Then, we mixed the serum samples of the other 76 participants in 10 pools and subjected them to next-generation sequencing. First, we tested for arboviruses in serum samples from 124 of the 200 participants using an arbovirus DNA microarray platform, which did not detect any virus. We recruited 200 subjects with suspected malaria in Manaus, Brazil. The aim of this study was to evaluate the potential for viral infections in patients with suspected malaria but without Plasmodium infection in the Brazilian Amazon. Patients with malaria and arboviral disease frequently show similar clinical presentation and laboratory findings, making the diagnosis of the cause of the infection challenging. In addition to arboviruses, malaria, caused by Plasmodium vivax, is endemic in the Amazon. The Brazilian Amazon region has the highest number of arboviruses detected worldwide. ![]() More than 150 arboviruses can cause febrile illness following infection in humans. Arthropod-borne viruses (arboviruses) are a significant public health threat, especially in tropical and subtropical regions. ![]()
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