Implementation of a Multiplex rRT-PCR for Zika, Chikungunya, and Dengue Viruses: Improving Arboviral Detection in an Endemic Region.

Arboviral diagnosis has been complicated throughout the tropical and subtropical Americas by the recent co-circulation of Zika virus (ZIKV), chikungunya virus (CHIKV), and dengue virus (DENV). The aim of this study was to implement a multiplex real-time RT-PCR (rRT-PCR) for ZIKV, CHIKV, and DENV in Paraguay to test patients who were clinically suspected of having dengue. We tested 110 sera from patients who presented to the Hospital de Clínicas in 2016 and had testing for DENV nonstructural protein 1 (NS1; 40 positive and 70 negative). Using a composite reference standard, we confirmed 51 dengue cases (46.4%): 38/40 NS1 positive and 13/70 NS1 negative. Chikungunya virus and ZIKV were detected in one sample each, both were DENV NS1 negative. The NS1 test demonstrated good agreement with rRT-PCR for DENV. However, multiplex rRT-PCR identified a subset of dengue cases and additional arboviral infections that would not be detected if NS1 assays are relied upon for diagnosis.

Donovanosis

Background: Adolescent patient, native (Nivacle) sexually active, from the central Paraguayan Chaco, with 9-month history of rectal bleeding and ulcerated lesions in the perianal region, pregnancy query term, we see the health personal injuries, and perform caesarean elective, was referred to a reference cancer center on suspicion of anal cancer before reaching the dx, received multiple antibiotic schemes, and when receiving the pathology report, with the resulting donovanosis suspected to our service, where he was treated specific antibiotic, in addition to practices a colostomy for recto-vaginal fistula, the patient presented favorable evolution, with restoration of intestinal transit after the closure of the fistula (3, 11 to 14).

Paciente adolescente, nativa (Nivacle) sexualmente activa, procedente del chaco central paraguayo, con historia de 9 meses de rectorragía y lesiones ulceradas en región peri-anal, consulta por embarazo a término, se constata las lesiones por personal de salud, y le realizan cesárea electiva, fue derivada a un centro oncológico de referencia por sospecha de de cáncer anal, antes de llegar al dx, recibió múltiples esquemas antibióticos, y cuando reciben el informe de anatomía patológica, con sospecha de donovanosis la derivan a nuestro servicio, donde recibió tratamiento antibiótico especifico, además de practicársele colostomía, por fístula recto-vaginal, la paciente presento evolución favorable, con restitución el tránsito intestinal una vez cerrado la fistula (3,11-14).