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Proesmans S, Katshongo F, Milambu J, Fungula B, Muhindo Mavoko H, Ahuka-Mundeke S, Inocêncio da Luz R, Van Esbroeck M, Ariën KK, Cnops L, De Smet B, Lutumba P, Van Geertruyden JP, Vanlerberghe V. Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study. PLoS Negl Trop Dis 2019; 13:e0007047. [PMID: 31487279 PMCID: PMC6748445 DOI: 10.1371/journal.pntd.0007047] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 09/17/2019] [Accepted: 08/06/2019] [Indexed: 12/25/2022] Open
Abstract
Background Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. Methodology We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections. Results Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue–caused by DENV-1 and/or DENV-2 –and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment. Discussion Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will–ultimately and hopefully–improve the clinical care of outpatients in low-resource settings. Trial registration ClinicalTrials.gov NCT02656862. Malaria remains one of the most important causes of fever in sub-Saharan Africa. However, its share is declining, since the diagnosis and treatment of malaria have improved significantly over the years. Hence leading to an increase in the number of patients presenting with non-malarial fever. Often, obvious clinical signs and symptoms like cough or diarrhea are absent, probing the question: “What causes the fever?” Previous studies have shown that the burden of arboviral infections–like dengue and chikungunya–in sub-Saharan Africa is underestimated, which is why we screened for four common arboviral infections in patients presenting with ‘undifferentiated fever’ at an outpatient clinic in suburban Kinshasa, Democratic Republic of Congo. Among the patients tested, we found that one in ten presented with an acute arboviral infection and that almost one in three patients had been infected in the past. These findings suggest that clinicians should think about arboviral infections more often, thereby refraining from the prescription of antibiotics, a practice increasingly problematic given the global rise of antimicrobial resistance.
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Affiliation(s)
| | - Freddy Katshongo
- Institut Supérieur des Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - John Milambu
- Centre Hospitalier Lisungi, Kinshasa, Democratic Republic of Congo
| | - Blaise Fungula
- Centre Hospitalier Lisungi, Kinshasa, Democratic Republic of Congo
| | - Hypolite Muhindo Mavoko
- University of Antwerp, Antwerp, Belgium.,Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- Université de Kinshasa, Kinshasa, Democratic Republic of Congo.,Institut National de Reserche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Kevin K Ariën
- University of Antwerp, Antwerp, Belgium.,Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Pascal Lutumba
- Université de Kinshasa, Kinshasa, Democratic Republic of Congo.,Institut National de Reserche Biomédicale, Kinshasa, Democratic Republic of Congo
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Deza-Cruz I, Mill A, Rushton S, Kelly P. Comparison of the Use of Serum and Plasma as Matrix Specimens in a Widely Used Noncommercial Dengue IgG ELISA. Am J Trop Med Hyg 2019; 101:456-458. [PMID: 31190684 PMCID: PMC6685565 DOI: 10.4269/ajtmh.19-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/05/2019] [Indexed: 11/07/2022] Open
Abstract
Although sera are most commonly used in serological diagnostic tests for dengue, sometimes only plasma containing ethylenediaminetetraacetic acid (EDTA) may be available. When we studied the performance of a widely used noncommercial dengue ELISA in the detection of reactive IgG in sera and plasma from the same individuals, we found no significant differences in the diagnostic performance of the assay. The inter-specimen coefficient of variation (CV) of the optical density was 0.081 and the concordance correlation coefficient (CCC) was 0.92, showing a very strong agreement between the two matrix specimens. The intra-specimen CV and CCC were higher for plasma than for serum at low dilutions, but similar at high dilutions. Overall, our results show that the performance of a widely used in-house ELISA using plasma containing EDTA is equivalent to serum with the recommendation to assay the plasma specimens in duplicate to reduce variability of results at lower dilutions.
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Affiliation(s)
- Iñaki Deza-Cruz
- Modelling Evidence and Policy Group, School of Natural and Environmental Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts and Nevis
| | - Aileen Mill
- Modelling Evidence and Policy Group, School of Natural and Environmental Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Steven Rushton
- Modelling Evidence and Policy Group, School of Natural and Environmental Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Patrick Kelly
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts and Nevis
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Jing Q, Li Y, Liu J, Jiang L, Chen Z, Su W, Birkhead GS, Lu J, Yang Z. Dengue Underestimation in Guangzhou, China: Evidence of Seroprevalence in Communities With No Reported Cases Before a Large Outbreak in 2014. Open Forum Infect Dis 2019; 6:ofz256. [PMID: 31304186 PMCID: PMC6612883 DOI: 10.1093/ofid/ofz256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/01/2019] [Indexed: 12/28/2022] Open
Abstract
Objective Dengue has become a serious public health problem in southern China particularly with a record-breaking outbreak in 2014. Serological evidence from areas with no known dengue cases reported prior to 2014 could provide information on possible unrecognized circulation of dengue virus (DENV) before this outbreak. Method Between March and May 2015, we performed a cross-sectional serosurvey using a stratified random sampling method among individuals aged 1-84 years-old in 7 communities in Guangzhou with no reported dengue cases before 2014. Sera of subjects were initially screened with the indirect DENV IgG enzyme-linked immunosorbent assay, and positive samples were further tested by the indirect immunofluorescence assay to identify specific serotypes. Results A total of 850 subjects had complete information available. The overall seroprevalence against DENV was 6.59% (56 of 850; 95% CI, 4.92%-8.26%). The seroprevalence increased with age in general (3.86%, 4.58%, 8.72%, 7.22%, and 10.69% among participants in ≤14, 15-29, 30-44, 45-59 and ≥60 years age group, respectively). Living in rural or peri-urban communities and longer years of residence therein were risk factors for higher seroprevalence, whereas wearing long sleeves and pants when outdoors was associated with lower seroprevalence. Of the total subjects, 55.36% (31 of 56) sera were successfully identified with specific serotypes, with 12.90% (4 of 31) being coinfected with 2 serotypes. Conclusions Dengue transmission in the study communities had occurred prior to the 2014 massive outbreak, possibly for many years, but went undiagnosed and unreported. A proportion of the study population experienced secondary infection as different serotypes of DENV increased the risk for severe diseases. Active surveillance and education of both healthcare providers and the general population should be conducted in areas at risk for dengue emergence in order to better reduce disease burden.
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Affiliation(s)
- Qinlong Jing
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
| | - Yilan Li
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
| | - Jianhua Liu
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
| | - Liyun Jiang
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
| | - Zongqiu Chen
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
| | - Wenzhe Su
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
| | - Guthrie S Birkhead
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, US
| | - Jiahai Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, People's Republic of China
| | - Zhicong Yang
- Department of Infectious Diseases, Guangzhou Center for Disease Control and Prevention, People's Republic of China
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Leslie TE, Carson M, Coeverden EV, De Klein K, Braks M, Krumeich A. An analysis of community perceptions of mosquito-borne disease control and prevention in Sint Eustatius, Caribbean Netherlands. Glob Health Action 2018; 10:1350394. [PMID: 28766466 PMCID: PMC5645715 DOI: 10.1080/16549716.2017.1350394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In the Caribbean, mosquito-borne diseases are a public health threat. In Sint Eustatius, dengue, Chikungunya and Zika are now endemic. To control and prevent mosquito-borne diseases, the Sint Eustatius Public Health Department relies on the community to assist with the control of Aedes aegypti mosquito. Unfortunately, community based interventions are not always simple, as community perceptions and responses shape actions and influence behavioural responses Objective: The aim of this study was to determine how the Sint Eustatius population perceives the Aedes aegypti mosquito, mosquito-borne diseases and prevention and control measures and hypothesized that increased knowledge of the virus, vector, control and prevention should result in a lower AQ1 prevalence and incidence of mosquito-borne diseases. METHODS This study was conducted in Sint Eustatius island in the Eastern Caribbean. We combined qualitative and quantitative designs. We conducted interviews and focus groups discussions among community member and health professional in 2013 and 2015. We also conducted cross-sectional survey to assess local knowledge on the vector, virus, and control and prevention. RESULTS The population is knowledgeable; ©however, mosquito-borne diseases are not the highest health priority. While local knowledge is sometimes put into action, it happens on the 20 household/individual level as opposed to the community level. After the 2014 CHIK outbreak, there was an increase in knowledge about mosquito control and mosquito-borne diseases. DISCUSSION In the context of Sint Eustatius, when controlling the Aedes population it may be a strategic option to focus on the household level rather than the community and build collaborations with households by supporting them when they actively practice mosquito 25 control. To further increase the level of knowledge on the significance of mosquito-borne diseases, it may also be an option to contextualize the issue of the virus, vector, prevention and control into a broader context. CONCLUSION As evidenced by the increasing number of mosquito-borne diseases on the island, it appears that knowledge amongst the lay community may not be transferred into 30 action. This may be attributed to the perception of the Sint Eustatius populations that mosquitoes and the viruses they carry are not a high priority in comparison to other health concerns.
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Affiliation(s)
- Teresa E Leslie
- a Eastern Caribbean Public Health Foundation , Sint Eustaitus , Caribbean Netherlands
| | - Marianne Carson
- b Pathobiology and Population Studies, Royal Veterinary College , London , UK
| | - Els van Coeverden
- c Department of Social Sciences , Wageningen University , Netherlands
| | - Kirsten De Klein
- c Department of Social Sciences , Wageningen University , Netherlands
| | | | - Anja Krumeich
- e Health Medicine and Life Science, University of Maastricht , Maastricht , Netherlands
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Montoya-Ruiz C, Rodas JD. Epidemiological Surveillance of Viral Hemorrhagic Fevers With Emphasis on Clinical Virology. Methods Mol Biol 2018; 1604:55-78. [PMID: 28986825 DOI: 10.1007/978-1-4939-6981-4_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
This article will outline surveillance approaches for viral hemorrhagic fevers. Specific methods for surveillance of clinical samples will be emphasized. Separate articles will describe methods for surveillance of rodent-borne viruses (roboviruses) and arthropod-borne viruses (arboviruses). Since the appearance of hantaviruses and arenaviruses in the Americas, more than 30 different species in each group have been established, and therefore they have become the most frequently emerging viruses. Flaviviruses such as yellow fever and dengue viruses, although easier to recognize, are also more widely spread and therefore considered a very important public health issue, particularly for under-developed countries. On the other hand, marburgviruses and ebolaviruses, previously thought to be restricted to the African continent, have recently been shown to be more global. For many of these agents virus isolation has been a challenging task: trapping the specific vectors (mosquitoes and ticks), and reservoirs (rodents and bats), or obtaining the samples from suspected clinical human cases demands special protective gear, uncommon devices (respirators), special facilities (BSL-3 and 4), and particular skills to recognize the slow and inapparent cytopathic effects in cell culture. Alternatively, serological and molecular approaches have been very helpful in discovering and describing newly emerging viruses in many areas where the previous resources are unavailable. Unfortunately, in many cases, detailed studies have been performed only after outbreaks occur, and then active surveillance is needed to prevent viral dissemination in human populations.
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Affiliation(s)
- Carolina Montoya-Ruiz
- Linea de Zoonosis Emergentes y Re-emergentes, Grupo Centauro, Facultad de Ciencias Agrarias, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia
| | - Juan David Rodas
- Linea de Zoonosis Emergentes y Re-emergentes, Grupo Centauro, Facultad de Ciencias Agrarias, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia.
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Antón SC, Malhi RS, Fuentes A. Race and diversity in U.S. Biological Anthropology: A decade of AAPA initiatives. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 165 Suppl 65:158-180. [DOI: 10.1002/ajpa.23382] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | - Ripan S. Malhi
- Department of AnthropologyUniversity of Illinois, Urbana Champaign
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Senaratne T, Wimalaratne H, Alahakoon DGS, Gunawardane N, Carr J, Noordeen F. Characterization of dengue virus infections in a sample of patients suggests unique clinical, immunological, and virological profiles that impact on the diagnosis of dengue and dengue hemorrhagic fever. J Med Virol 2016; 88:1703-10. [PMID: 26990973 DOI: 10.1002/jmv.24525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/08/2022]
Abstract
Dengue virus (DENV) infections are increasing with respect to incidence and severity in the Central Province of Sri Lanka. The objective of this study was to define the clinical, immunological, and virological profiles of patients admitted to the General Hospital, Kandy with clinically apparent dengue. Demographic, clinical, hematological parameters, liver enzymes (ALT and AST), and blood samples were collected from 292 patients with fever <5 days post onset and fulfilling the WHO criteria for the diagnosis of dengue fever/dengue hemorrhagic fever (DF/DHF). Samples were analyzed for, anti-DENV IgM, IgG, and DENV nucleic acid. Myalgia was the commonest complaint by 65% of the patients. Packed cell volume was >45% in 27% of the patients while 42.12% had reduced platelets and 62.67% had reduced white blood cell counts. In contrast to other studies, positive tourniquet test (PTT) and petechiae were not major indicators of DENV infection or severity of the disease. Clinical profiles were significantly different between DF and DHF/DSS and showed many similarities to that reported elsewhere. Altogether, 43 patients (14.73%) were viremic as detected by RT-PCR; 181 patients (62%) were positive for anti-DENV IgM, and 245 (84%) patients were positive for anti-DENV IgG. In combination, anti-DENV IgM and RT-PCR assays detected 224 (77.5%) of DENV infected cases, thus improving the DENV diagnosis rate. Hence, the diagnostic utility of PTT, anti-DENV IgM/IgG serology, or RT-PCR used alone in the early phase of illness is low in Sri Lanka but the diagnostic value can be improved by a combination of serology and RT-PCR. J. Med. Virol. 88:1703-1710, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thamarasi Senaratne
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | - Jillian Carr
- Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, South Australia
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Suryapranata FST, Ang CW, Chong LL, Murk JL, Falconi J, Huits RMHG. Epidemiology of Guillain-Barré Syndrome in Aruba. Am J Trop Med Hyg 2016; 94:1380-4. [PMID: 27022152 DOI: 10.4269/ajtmh.15-0070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022] Open
Abstract
The epidemiology of Guillain-Barré syndrome (GBS) in tropical areas is different compared with developed countries. We investigated the epidemiology of GBS on the Caribbean island of Aruba. Data were collected retrospectively from all 36 patients hospitalized with GBS between 2003 and 2011 in Aruba. We observed a seasonal distribution of GBS cases with a peak in February. The incidence rate (IR) fluctuated heavily between individual years. The overall IR was 3.93/100,000, which is higher than that observed in developed countries. Serological studies indicated a possible relation of GBS cases with dengue virus infections. We also observed a relation between the annual number of dengue cases in Aruba and the number of GBS cases in the same year. We conclude that the epidemiology of GBS in tropical areas can be different from temperate climate regions and that dengue may be a trigger for developing GBS.
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Affiliation(s)
- Franciska S T Suryapranata
- Department of Medical Microbiology and Infection Control, VU University Medical Centre (VUMC), Amsterdam, The Netherlands; Department of Neurology, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Internal Medicine, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Microbiology, Landslaboratorium, Oranjestad, Aruba; Department of Virology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands; Institute of Tropical Medicine, Antwerp, Belgium
| | - C Wim Ang
- Department of Medical Microbiology and Infection Control, VU University Medical Centre (VUMC), Amsterdam, The Netherlands; Department of Neurology, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Internal Medicine, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Microbiology, Landslaboratorium, Oranjestad, Aruba; Department of Virology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands; Institute of Tropical Medicine, Antwerp, Belgium
| | - Luis L Chong
- Department of Medical Microbiology and Infection Control, VU University Medical Centre (VUMC), Amsterdam, The Netherlands; Department of Neurology, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Internal Medicine, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Microbiology, Landslaboratorium, Oranjestad, Aruba; Department of Virology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands; Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Luc Murk
- Department of Medical Microbiology and Infection Control, VU University Medical Centre (VUMC), Amsterdam, The Netherlands; Department of Neurology, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Internal Medicine, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Microbiology, Landslaboratorium, Oranjestad, Aruba; Department of Virology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands; Institute of Tropical Medicine, Antwerp, Belgium
| | - Jaime Falconi
- Department of Medical Microbiology and Infection Control, VU University Medical Centre (VUMC), Amsterdam, The Netherlands; Department of Neurology, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Internal Medicine, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Microbiology, Landslaboratorium, Oranjestad, Aruba; Department of Virology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands; Institute of Tropical Medicine, Antwerp, Belgium
| | - Ralph M H G Huits
- Department of Medical Microbiology and Infection Control, VU University Medical Centre (VUMC), Amsterdam, The Netherlands; Department of Neurology, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Internal Medicine, Dr Horacio E. Oduber Hospital, Oranjestad, Aruba; Department of Microbiology, Landslaboratorium, Oranjestad, Aruba; Department of Virology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands; Institute of Tropical Medicine, Antwerp, Belgium
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