Retrospective meta-transcriptomic identification of severe dengue in a traveller returning from Africa to Sweden, 1990
Kristian Alfsnes,
Nina Lagerqvist,
Sirkka Vene,
Jon Bohlin,
Jenny Verner-Carlsson,
David Ekqvist,
Andreas Bråve,
Edward C. Holmes,
Weifeng Shi,
John H.-O. Pettersson
Affiliations
Kristian Alfsnes
Infectious Disease Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
Nina Lagerqvist
Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden
Sirkka Vene
Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden
Jon Bohlin
Infectious Disease Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
Jenny Verner-Carlsson
Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden
David Ekqvist
Department of Infectious Diseases, University Hospital Linköping, Sweden
Andreas Bråve
Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden
Edward C. Holmes
Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and School of Medical Sciences, the University of Sydney, Sydney, New South Wales 2006, Australia
Weifeng Shi
School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian 271016, China
John H.-O. Pettersson
Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and School of Medical Sciences, the University of Sydney, Sydney, New South Wales 2006, Australia; Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Sweden; Corresponding author at: Public Health Agency of Sweden, Nobels väg 18, SE-171 82 Solna, Sweden.
Pathogens associated with haemorrhagic fever commonly have zoonotic origins. The first documented imported case of likely viral severe haemorrhagic fever in Sweden occurred in 1990. Despite extensive study, no aetiological agent was identified. Following retrospective investigation with total RNA-sequencing of samples collected between 7 and 36 days from onset of symptoms we identified dengue virus 3 (DENV-3) and a human pegivirus (HPgV). We conclude that the patient likely suffered from haemorrhagic symptoms due to an atypical severe and undiagnosed dengue infection.
