The patient was, therefore, admitted to our hospital for treatment, given intravenous infusions and observed for dengue warning signs. The patient’s platelet count was at its lowest on day 7 after onset
of disease (48 × 109/L) and her fever subsided on day 8 after onset. She was discharged after hospitalization for a total of 7 days. DENV-3 genome was detected by real-time polymerase chain reaction (RT-PCR, Applied Biosystems, USA) and virus isolated using the Aedes albopictus mosquito cell line C6/36. Although tests for anti-dengue IgM (Focus Diagnostics, USA), and IgG (Panbio, Australia) antibodies were negative on day 2 after onset of disease, tests using serum sample from day 8 after Nutlin-3a order onset of disease was positive. Both day 2 and day 8 serum samples were positive for dengue NS1 antigen (Platelia, LDK378 in vivo Bio-Rad, France). Serum samples were de-identified prior to being used in the experiments and thus, ethical approval was not required for this study. The nucleotide sequence of the envelope protein (E-protein) of the isolated virus (GenBank accession number AB690858) was compared to selected sequences of DENV-3. The isolated DENV-3 strain from Benin belonged to DENV-3,
genotype III (Figure 1) and had the following characteristics: an E-protein sequence similarity of 99% to the DENV-3 D3/Hu/Côte d’Ivoire/NIID48/2008 strain, 99% to a DENV-3 strain isolated in Senegal in 2009, and 98% to a DENV-3 D3/Hu/Tanzania/NIID08/2010 strain isolated in Tanzania in 2010 (GenBank accession numbers: AB447989, GU189386, and AB549332, respectively). Sporadic cases or outbreaks of DENV infection have been reported in 34 countries in the African region. It is estimated Miconazole that 2.4% of global dengue hemorrhagic fever (DHF) cases (100,000 cases) and up to 1 million cases of DF may occur in Africa. Among travel-associated dengue cases in travelers returning to Europe, 2 to 8% had visited Africa.[2, 5] In comparison, most of
the travelers returning to Europe with dengue had traveled to Asia (54–61%) and Latin America (25–31%). Febrile illness was, however, more frequently reported in 41% of travelers to sub-Saharan Africa (2,559 patients) as compared to other regions (Southeast Asia, 33%, 1,218 patients; Caribbean and Central and South America, 18%, 1,044 patients). Although dengue is frequently reported in travelers to Southeast Asia and South America as compared to Africa, the disease may be underreported in Africa due to limited awareness of the disease, and, limited availability of diagnostic tests and routine surveillance system. Imported cases of DENV type-3 infection from West Africa have been previously reported in European travelers.[2-6] The first possibility of DENV circulation in Benin was suggested by a seroprevalence study conducted in asymptomatic Germans working overseas from 1987 to 1993.