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Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response.
J Infect Dis. 2008 Mar 15; 197(6):817-24.JI

Abstract

BACKGROUND

Clinical manifestations of dengue vary in different areas of endemicity and between specific age groups, whereas predictors of outcome have remained controversial. In Brazil, the disease burden predominantly affects adults, with an increasing trend toward progression to dengue hemorrhagic fever (DHF) noted.

METHODS

A cohort of adults with confirmed cases of dengue was recruited in central Brazil in 2005. Patients were classified according to the severity of their disease. Associations of antibody responses, viremia levels (as determined by real-time polymerase chain reaction [PCR]), and serotypes (as determined by multiplex PCR) with disease severity were evaluated.

RESULTS

Of the 185 symptomatic patients >14 years of age who had a confirmed case of dengue, 26.5% and 23.2% were classified as having intermediate dengue fever (DF)/DHF (defined as internal hemorrhage, plasma leakage, manifested signs of shock, and/or thrombocytopenia [platelet count, < or =50,000 platelets/mm3]) and DHF, respectively. The onset of intermediate DF/DHF and DHF occurred at a late stage of disease, around the period of defervescence. Patients with DHF had abnormal liver enzyme levels, with a >3-fold increase in aspartate aminotransferase level, compared with the range of values considered to be normal. Overall, 65% of patients presented with secondary infections with dengue virus, with such infection occurring in similar proportions of patients in each of the 3 disease category groups. Dengue virus serotype 3 (DV3) was the predominant serotype, and viremia was detected during and after defervescence among patients with DHF or intermediate DF/DHF.

CONCLUSIONS

Viremia was detected after defervescence in adult patients classified as having DHF or intermediate DF/DHF. Secondary infection was not a predictor of severe clinical manifestation in adults with infected with the DV3 serotype.

Authors+Show Affiliations

Instituto de Patologia Tropical e Saude Publica, Universidade Federal de Goias, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18269315

Citation

Guilarde, Adriana O., et al. "Dengue and Dengue Hemorrhagic Fever Among Adults: Clinical Outcomes Related to Viremia, Serotypes, and Antibody Response." The Journal of Infectious Diseases, vol. 197, no. 6, 2008, pp. 817-24.
Guilarde AO, Turchi MD, Siqueira JB, et al. Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response. J Infect Dis. 2008;197(6):817-24.
Guilarde, A. O., Turchi, M. D., Siqueira, J. B., Feres, V. C., Rocha, B., Levi, J. E., Souza, V. A., Boas, L. S., Pannuti, C. S., & Martelli, C. M. (2008). Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response. The Journal of Infectious Diseases, 197(6), 817-24. https://doi.org/10.1086/528805
Guilarde AO, et al. Dengue and Dengue Hemorrhagic Fever Among Adults: Clinical Outcomes Related to Viremia, Serotypes, and Antibody Response. J Infect Dis. 2008 Mar 15;197(6):817-24. PubMed PMID: 18269315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response. AU - Guilarde,Adriana O, AU - Turchi,Marilia D, AU - Siqueira,Joao Bosco,Jr AU - Feres,Valeria C R, AU - Rocha,Benigno, AU - Levi,Jose E, AU - Souza,Vanda A U F, AU - Boas,Lucy Santos Vilas, AU - Pannuti,Claudio S, AU - Martelli,Celina M T, PY - 2008/2/14/pubmed PY - 2008/6/6/medline PY - 2008/2/14/entrez SP - 817 EP - 24 JF - The Journal of infectious diseases JO - J Infect Dis VL - 197 IS - 6 N2 - BACKGROUND: Clinical manifestations of dengue vary in different areas of endemicity and between specific age groups, whereas predictors of outcome have remained controversial. In Brazil, the disease burden predominantly affects adults, with an increasing trend toward progression to dengue hemorrhagic fever (DHF) noted. METHODS: A cohort of adults with confirmed cases of dengue was recruited in central Brazil in 2005. Patients were classified according to the severity of their disease. Associations of antibody responses, viremia levels (as determined by real-time polymerase chain reaction [PCR]), and serotypes (as determined by multiplex PCR) with disease severity were evaluated. RESULTS: Of the 185 symptomatic patients >14 years of age who had a confirmed case of dengue, 26.5% and 23.2% were classified as having intermediate dengue fever (DF)/DHF (defined as internal hemorrhage, plasma leakage, manifested signs of shock, and/or thrombocytopenia [platelet count, < or =50,000 platelets/mm3]) and DHF, respectively. The onset of intermediate DF/DHF and DHF occurred at a late stage of disease, around the period of defervescence. Patients with DHF had abnormal liver enzyme levels, with a >3-fold increase in aspartate aminotransferase level, compared with the range of values considered to be normal. Overall, 65% of patients presented with secondary infections with dengue virus, with such infection occurring in similar proportions of patients in each of the 3 disease category groups. Dengue virus serotype 3 (DV3) was the predominant serotype, and viremia was detected during and after defervescence among patients with DHF or intermediate DF/DHF. CONCLUSIONS: Viremia was detected after defervescence in adult patients classified as having DHF or intermediate DF/DHF. Secondary infection was not a predictor of severe clinical manifestation in adults with infected with the DV3 serotype. SN - 0022-1899 UR - https://www.unboundmedicine.com/medline/citation/18269315/Dengue_and_dengue_hemorrhagic_fever_among_adults:_clinical_outcomes_related_to_viremia_serotypes_and_antibody_response_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1086/528805 DB - PRIME DP - Unbound Medicine ER -