Dengue and hepatitis E virus infection in pregnant women in Eastern Sudan, a challenge for diagnosis in an endemic area
Adel Hussein Elduma, Waleed Mohammed Osman
The Pan African Medical Journal. 2014;19:391. doi:10.11604/pamj.2014.19.391.5439

Create an account  |  Sign in
PAMJ Conf Proceedings PAMJ Conf Proceedings
"Better health through knowledge sharing and information dissemination "

Short communication

Dengue and hepatitis E virus infection in pregnant women in Eastern Sudan, a challenge for diagnosis in an endemic area

Cite this: The Pan African Medical Journal. 2014;19:391. doi:10.11604/pamj.2014.19.391.5439

Received: 18/09/2014 - Accepted: 04/11/2014 - Published: 18/12/2014

Key words: Dengue, HEV, pregnant women, Port Sudan

© Adel Hussein Elduma et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/19/391/full

Corresponding author: Adel Hussein Elduma, National Public Health laboratory, Federal Ministry of health, Khartoum, Sudan (dumanet@yahoo.com)


Dengue and hepatitis E virus infection in pregnant women in Eastern Sudan, a challenge for diagnosis in an endemic area

 

Adel Hussein Elduma1,&, Waleed Mohammed Osman2

 

1National Public Health laboratory, Ministry of Health, Sudan, 2Department of Epidemiology, Red Sea state Ministry of Health, Sudan

 

 

&Corresponding author
Adel Hussein Elduma, National Public Health laboratory, Federal Ministry of health, Khartoum, Sudan

 

 

Abstract

Dengue fever and hepatitis E virus infection are both a public health problem in developing countries due to poor sanitation. Infection with viral hepatitis and dengue fever can present with similar clinical such and fever, headache and abortion. This study was conducted in Port-Sudan city in the eastern part of the country. ELISA and Real Time PCR tests were used to detect the infection. A total number of 39 pregnant women with a mean age 26 ±7.8 were included in the study. All of them had fever, 32 (92.3%) admitted with headache, 11 (28.2%) of them had vomiting, and abortion was reported in two cases (5.1%). The study showed that 4 ( 10.3% ) of pregnant women were positive for the Hepatitis E virus, 5 ( 12.8%) positive for Dengue virus IgG, and only one sample (2.6%) was positive for IgM capture ELISA and real time PCR . Death due to hepatitis E infection was reported in one case with 7th month of pregnancy. Most of hepatitis cases were reported in the central sector of the Portsudan city. The diagnosis of hepatitis E virus and dengue virus in an endemic area is a great challenge for health care staff working in these areas. Both Dengue virus and Hepatitis E virus infection should be considered in pregnant women especially in similar settings.

 

 

Introduction

Dengue fever and hepatitis E virus infection are both a public health problem in developing countries due to poor sanitation. Infection with viral hepatitis and dengue fever can present with similar clinical such and fever, headache and abortion. Dengue haemorrhagic fever and dengue fever are an arboviral disease caused by dengue virus, belong to the genus Flavivirus, family Flaviviridae. Dengue virus is a vector borne disease transmitted mainly by Aedes aegypti [1]. Dengue outbreaks have been reported in the Eastern Mediterranean Region as early as 1799 in Egypt [2]. In Africa, data regarding dengue virus outbreaks are poor, but there are many evidences which indicated that the dengue viruses 1&2 appear to be common causes of acute fever such as in Comoros and Mozambique [3]. In recent years, dengue fever and dengue haemorrhagic fever become a public health problem in the eastern part of the country and mainly portsudan city. But this disease has a long history in this area and first outbreak was reported by Balfour and Archibald in 1908 [4]. In study conducted by Hyams and. al. 1986 involved febrile cases in Portsudan, he reported a dengue virus infection in 20% of the samples collected during his study [5]. The first case of hepatitis E virus was reported in Sudan in 1992, where acute sporadic cases were found among Sudanese children. Acute infection hepatitis E (positive for IgM anti-HEV) was found in (59%) of the study population [6]. In Darfur, Sudan, acute hepatitis E virus infection was confirmed in 95% of the suspected cases with hepatitis in 2004 [7].

 

 

Methods

The total number of 39 women admitted the Port Sudan Maternity hospital with fever symptoms were included in this study. The study duration was between January and April 2012.A.Data was analysed by using SPSS. Informed consent was taken from each participant. For laboratory diagnosis; Enzyme linked immune assay capture, ELISA, was used to detect the Dengue virus IgM and IgG from patient's serum. Commercial kit (Dengue IgM and IgG capture ELISA) was used to detect both IgM and IgG antibodies. Reaction result was read by the ELISA reader at 450 nm with reference filter of 600-650nm absorption [8]. ELISA kit (MP diagnostics) was also used to detect HEV IgM antibodies from pregnant women [9]. RNA was extracted from serum and kept at -80 C° until the PCR done. RNA was extracted by using a QIAamp viral RNA kit (QIAamp, GmHb, Germany). The result of both dengue and hepatitis E viruses were confirmed by using Real time PCR (Rotorgene 6000).

 

 

Results

A total number of 39 pregnant women with a mean age 26 ±7.8 were included in the study. All of them had fever, 32 (92.3%) admitted with headache, 11 (28.2%) of them had vomiting, and abortion was reported in two cases (5.1%). The study showed that 4 (10.3%) of pregnant women were positive for the Hepatitis E virus, 5 (12.8%) positive for Dengue virus IgG, and only one (2.6%) were positive for Dengue IgM capture ELISA (Table 1). Real Time PCR was done for all hepatitis E and dengue (including IgM and IgG) positive samples. Death due to hepatitis E infection was reported in one case with 7th month of pregnancy. Most of hepatitis cases among pregnant women were reported in the central sector of the Portsudan city and it was statistically significant (p= 0.013) (Table 2). Two samples of hepatitis E virus were positive by Real Time PCR.

 

 

Discussion

Dengue virus infection and hepatitis R virus infection symptoms and clinical signs are similar and it is difficult to distinguish especially during the acute phase of infection. These medical signs and symptoms include Fever, headache, and Jaundice. A study conducted in India among pregnant woman, dengue virus infection was presented mainly with myalgia plus a few cases with fever and abdominal pain [10]. Furthermore, fever and abdominal pain were observed in pregnant women infected with hepatitis E virus in Ghana [11]. There are many risk factors enhance the viral replication and expression in women such as malnutrition, and folate deficiency [12]. In a study conducted in Pakistan found that women was infected with Dengue virus and hepatitis E virus which support our study in the ability for mixed infection [13]. Moreover, another study was conducted in India found that a young man was infected with, dengue, HEV, and Leptospira in the same time. This case was confusing to treating physician because of several overlapping of clinical features of these diseases [14]. This result was supported by another study conducted among journalist and relief workers in Somalia, 1992-1993. Dengue virus and hepatitis E infection were reported among suspected cases admitted to hospital with clinical symptoms include fever and hepatitis [15].

 

 

Conclusion

The diagnosis of hepatitis E virus and dengue virus in an endemic area is a great challenge for health care staff working in these areas. Both Dengue virus and Hepatitis E virus infection should be considered in pregnant women especially in areas where these diseases are circulated.

 

 

Competing interests

The authors declare no competing interests.

 

 

Authors’ contributions

Collection of data was conducted by the second author, while laboratory work, data analysis, and manuscript preparation was done by the first authors. All authors have read and agreed to the final version of this manuscript and have equally contributed to its content and to the management of the case.

 

 

Tables

Table 1: dengue and hepatitis E virus infection among pregnant women

Table 2: distribution of positive cases in different areas of Port Sudan city

 

 

References

  1. Messer WB, Gubler DJ, Harris E, Sivananthan K, de Silva AM. Emergence Emergence and global spread of a dengue serotype 3, subtype III virus. Emerging Infectious Diseases. 2003; 9(7):800-809. PubMed | Google Scholar

  2. World Health Organization, Regional Office for the Eastern Mediterranean. Division of Communicable Disease Control, Newsletter. 2005. http://www.emro.who.int/pdf/dcdnewsletter6.pdf . accessed 2005.

  3. Gubler DJ, Sather GE, Kuno G, Cabral JR. Dengue 3 Virus Transmission in Africa. American Journal of Tropical, Medicine and Hygiene. 1986; 35(6):1280.1284. PubMed | Google Scholar

  4. Balfour A and Archiblad RG. Review of some of the recent advances in tropical medicine, hygiene and tropical veterinary science. London. Pub. For Department of education.1908. Google Scholar

  5. Hyames K C, Oldfield E O, Scott RM, Bourgeois AL, Gardiner H, Pazzaglia G, Moussa M, Saleh A S, Dawi OE, Daniell FD. Evaluation of febrile patients in Port Sudan, Sudan: isolation of dengue virus. The American Society of Tropical Medicine and Hygiene. 1986; 35(4):860-865. PubMed | Google Scholar

  6. Hyams KC, et al. Acute sporadic hepatitis E in Sudanese children: analysis based on a new western blot assay. J Infect Dis. 1992; 165(6):1001-1005. PubMed | Google Scholar

  7. Boccia D, Guthmann JP, Klovstad H, Hamid N, Tatay M, Ciglenecki I, Nizou JY, Nicand E, Guerin PJ. High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan .Clin Infect Dis. 2006; 42(12):1679-84. PubMed | Google Scholar

  8. Chuan-Liang Kao, Chwan-Chuen King, Day-Yu Chao, Hui-Lin Wu, Gwong-Jen J Chang. Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health. " J Microbiol Immunol Infect. 2005; 38(1): 5-16. PubMed | Google Scholar

  9. Lequin RM. Enzyme immunoassay (EIA)/enzyme-linked immunosorbent assay (ELISA). Clinical Chemistry.2005; 51(12):2415-2418. PubMed | Google Scholar

  10. Chitra TV & Seetha Panicker. Maternal and fetal outcome of dengue fever in pregnancy. J Vector Borne Dis. 2011; 48 (4):210-213. PubMed | Google Scholar

  11. Bonney JHK, Kwame-Aryee RA, Obed S, Tamatey AA, Barnor JS, Armah NB, Oppong SA, Osei-Kwesi M. Fatal hepatitis E viral infection in pregnant women in Ghana: a case series. BMC Res Notes. 2012; 5: 478. PubMed | Google Scholar

  12. Thio CL, Carrington M, Marti D, O'Brien SJ, Vlahov D, Nelson KE, et al. Class II HLA alleles and hepatitis B virus persistence in African Americans. JInfect Dis. 1999; 179 (4): 1004-1006. PubMed | Google Scholar

  13. Yakoob J, Jafri W, Siddiqui S, Riaz M. Dengue fever with hepatitis E and hepatitis A infection. Journal of the Pakistan Medical Association. 2009; 59(3):176-177. PubMed | Google Scholar

  14. Behera et al. Co-infections due to Leptospira, Dengue and Hepatitis E. J Infect Dev Ctries. 2010; 4(1):48-50. PubMed | Google Scholar

  15. Sharp TW, DeFraites RF, Thornton SA, Burans JP, Wallace MR. Illness in Journalists and Relief Workers Involved in International Humanitarian Assistance Efforts in Somalia, 1992-93. J Travel Med. 1995; 2 (2):70-76. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 27 (May - August 2017)

Article tools

Rate this article

Altmetric

Popular articles in Short communication

PAMJ is a member of the Committee on Publication Ethics

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2017 - Pan African Medical Journal. All rights reserved