Detection of Dengue Virus among Children with Suspected Malaria, Accra, Ghana

We report new molecular evidence of locally acquired dengue virus infections in Ghana.We detected dengue viral RNA among children with suspected malaria by using a multipathogen real-time PCR.Subsequent sequence analysis revealed a close relationship with dengue virus serotype 2, which was implicated in a 2016 outbreak in Burkina Faso. T he accurate diagnosis of nonmalarial febrile illnessesremains a large challenge in many malaria-endemic countries (1).The etiologic agents in this context are often not identified because of nonspecific clinical symptoms and diagnostic limitations (2); for example, of 457 patients in Nigeria who were presumptively treated for malaria, only 3.9% tested positive (3).Because of the decline in malaria transmission over the past decade in many endemic areas, including Ghana, there is a critical need for a comprehensive characterization of the etiology of acute febrile illness (AFI) (4).Dengue virus infections cause symptoms that are similar to those of malaria, and considering the increasing reports of dengue outbreaks in countries neighboring Ghana (5-8), there is an increased need for dengue surveillance. The StudyTo obtain a description of the pathogens causing febrile illnesses in Ghana, we conducted a hospital-based crosssectional study among children in 2 geographically distinct areas.Kintampo, in the Brong Ahafo region, is a semiurban area in the forest savanna middle belt and has a population of 42,957.Teshie is a periurban area in the Greater Accra region that has ≈171,875 residents (online Technical Appendix Figure https://wwwnc.gov/EID/article/24/8/18-0341-Techapp1.pdf).We conducted the study during October 2016-July 2017, encompassing parts of the dry season (November-March) and rainy season (April -July).Children 1-15 years of age whose symptoms included fever were examined in the outpatient departments of Kintampo Municipal Hospital or Ledzokuku Krowor Municipal Assembly Hospital in Teshie.The study was approved by the ethics review committees of the Noguchi Memorial Institute for Medical Research, University of Ghana, the Ghana Health Service, and the Kintampo Health Research Centre.We recruited the patients for this study after we obtained written informed consent from their parents or guardians.The inclusion criteria were fever within the preceding 24 hours or measured axillary temperature ≥38°C occurring for <7 days and no severe or known chronic disease.Attending clinicians at the 2 sites screened a total of 10,234 children, and 700 were enrolled for the study on the basis of the inclusion criteria.We collected venous blood (5 mL) from each participant into EDTA-containing tubes (BD Vacutainer; Becton Dickinson, Franklin Lakes, NJ, USA) for malaria tests and full blood counts; the remaining blood was stored at -80°C until use.All of the children were treated according to the Ghana Health Service treatment guidelines.We randomly selected stored blood samples from 166 children diagnosed with AFI and screened the samples by using a customized multipathogen, real-time PCR-based TaqMan probe-array card (TAC; Applied Biosystems, Carlsbad, CA, USA), as described by Liu et al. (9).The AFI TAC assay simultaneously tests for 26 pathogens, including 3 protozoa, 7 bacteria, and 16 viruses (Table 1).Each card tests 6 samples and 2 controls (9).As we expected, Plasmodium spp. was the predominant pathogen detected in samples from the children (36.8% of samples tested; Table 2).Salmonella enterica Detection of Dengue Virus among Children with Suspected Malaria, Accra, Ghana 1544