Screening of virus infection in febrile patients with suspected malaria in the Brazilian Amazon

Arthropod-borne viruses (arboviruses) represent a threat for global public health, especially in the tropical and subtropical regions of the world. The Brazilian Amazon is where the highest number of arboviruses has been detected in the world. It is often difficult to differentiate between malaria and arboviral diseases, as they share similar clinical features, mainly undifferentiated fever. This study aimed to estimate possible viral etiology in patients with febrile syndrome negative for Plasmodium infection, in the Brazilian Amazon. We initially analyzed serum samples of 124 participants with a DNA microarray platform designed for the detection of arboviruses and viruses transmitted by small mammals, but no virus was detected. Then, the serum samples of 76 participants were analyzed with a deep New Generation Sequencing, which showed evidence of the presence of only one arbovirus, the Zika virus in only one pool of 9 serum samples, showing that arboviruses are not frequent in suspected malaria cases in Manaus, Brazil. Other viruses instead of arboviruses were found in this study, mainly Primate erythrovirus 1 and Enterobacteria phage lambda. Cost-effective and simple high throughput methods are required for helping molecular surveillance of misdiagnosed viral infections.