Dengue virus infection amongst malaria and typhoid fever suspected acute febrile patients in the Niger river basin of Nigeria

In recent decades, the burden of dengue fever has increased substantially across the globe, making it a major public health concern, particularly in tropical and subtropical regions. Unfortunately, dengue is often misdiagnosed and mismanaged as malaria and typhoid fever in endemic areas due to shared clinical symptoms. Although dengue has been reported in other parts of Nigeria, there is currently no documented evidence of the disease in the Niger River basin area, which is a site of attraction for most tourist visitors. In a cross-sectional study, blood samples were obtained from 200 consenting febrile patients from three health facilities in the Niger River Basin area. Dengue virus (DENV) antigen and antibodies were simultaneously detected using the NS1 and DENV IgG/IgM immunoassay kit. Further, the samples were screened for malaria parasite and typhoid bacteria using malaria parasite examination and the Widal test, respectively. Thirty-eight (19.0%) of the 200 patients tested had detectable anti-DENV antibodies, out of which 27(13.5%) were anti-DENV IgG, 8(4.0%) anti-DENV IgM, while 1(0.5%) each was for DENV NS1, both IgG and IgM, and IgG, IgM, and NS1 combined. The overall malaria and typhoid positivity were 104(52%) and 125 (62.5%), respectively. Dengue, malaria, and typhoid monoinfections were 27(13.5%), 37(18.5%), and 58(29%), respectively. Dual malaria and typhoid, dengue and malaria, and dengue and typhoid were 58 (29%), 2 (1%), and 2 (1%), respectively, while 7 (4%) had triple infection. Risk factors for dengue infection included being aged 41-50 years, farming occupation, being married, and environmental factors such as uncovered water containers and stagnant water. Symptoms significantly associated with active dengue included back pain and nausea. This study identified both active and previous dengue in the Niger River Basin area. The high burden of dengue and evidence of co-infections with endemic malaria and typhoid among febrile patients highlight the importance of differential diagnosis to avoid inappropriate treatment.