Correlation of disease spectrum among four Dengue serotypes: a five years hospital based study from India

Abstract

The recognition of DF (DHF Dengue Hemorrhagic Fever) is very complicated due to occurrence of a wide spectrum of clinical signs and symptoms during acute phase of illness. Moreover, presence of four serotypes further complicates the prognosis. To investigate the predictors of disease severity and elucidate the prognostic markers among four dengue serotypes, this study was conducted on 320 inpatients having acute febrile illness clinically suspected as DI, over a period of fi ve years. Dengue serotypes were confi rmed by multiplex reverse transcriptase (RT)-PCR. Eighty patients were positive for DI with presence of Den-1, Den-2, Den-3, and Den-4 in 8, 35, 27 and 10 patients, respectively. The severe clinical manifestations, abdominal pain and hepatomegaly, were comparatively higher in Den-2 patients. Liver aminotransferases levels were also higher in Den-2 patients (app. 5 fold). This study clearly indicates the hyperendemicity of all dengue serotypes. Nucleotide sequencing of Envelope region revealed that the presently emerged Den-3 belongs to type III, having high homology with genotype responsible for number of outbreaks in 1980s. The re-emergence of this deadly type can be suspected to cause more outbreaks in future and is a matter of great concern.

Variation in Inflammatory/Regulatory Cytokines in Secondary, Tertiary, and Quaternary Challenges with Dengue Virus

“…9,32 Population-based epidemiologic studies have shown that infection with DENV-2 in persons previously infected with a different dengue serotype is a major risk factor for DHF and DSS. [33][34][35][36][37] However, despite co-circulation of several dengue serotypes in the Americas, it was not until the epidemic of 1981 in Cuba that the first DHF cases occurred; this coincided with the introduction of a new genetic type of DENV-2, the Southeast Asian genotype. 38,39 Since that time, other countries in the Americas have reported DHF associated with secondary dengue serotype 2 viruses of the Southeast Asian genotype and not the indigenous American genotype.…”

“…DENV-2 has been the serotype most associated with disease severity in the course of a secondary infection, [33][34][35][36][37] and high levels of TNF-α and IFN-γ have been frequently associated with severe dengue. 6,28,[54][55][56][57][58][59][60] This finding is not consistent with higher IFNγ and TNF-α responses observed in PBMC from dengue-naive persons in response to DENV-2 challenge, especially if one considers that DENV-2 primary infection is frequently mild or asymptomatic.…”

Molecular Detection and Typing of Dengue Viruses from Archived Tissues of Fatal Cases by RT-PCR and Sequencing: Diagnostic and Epidemiologic Implications

“…43,44 Moreover, the genotypes originating in Southeast Asia and the Indian subcontinent, which belongs to serotype 2 and 3, respectively, have been identified to cause more outbreaks of severe dengue disease. 41,[45][46][47] Although the host immune status can also play an important role in determining the outcome of infection, 35 the determination of the virus nucleotide sequences in the fatal cases can help to identify the origin and serotype of the infecting virus and its association with severe disease and fatality. Furthermore, we also observed that out of 36 dengue-positive cases from Puerto Rico, all the cases that occurred from 1998 to 2003 were DENV-3 cases.…”

Penentuan Serotipe Virus Dengue dan Gambaran Manifestasi Klinis serta Hematologi Rutin pada Infeksi Virus Dengue

“…Manifestasi klinis yang lebih ringan disebabkan karena DENV-4. [3][4][5][6] Serotipe virus dengue di suatu daerah selalu mengalami perubahan, dengan demikian sangat diperlukan surveilans kontinu terhadap serotipe virus dengue untuk memahami epidemiologi dan juga memprediksi manifestasi klinis infeksi karena virus dengue termasuk hasil pemeriksaan hematologi rutin untuk melihat kecenderungan infeksi berat akibat infeksi serotipe virus dengue tertentu. Penentuan serotipe virus dengue penting untuk epidemiologi dan juga menentukan potensi patogenitas penyakit tersebut terhadap populasi.…”

“…18 Penelitian ini mendapatkan kasus DBD lebih banyak ditemukan pada infeksi oleh DENV-3 (6 kasus) diikuti oleh DENV-2 (3 kasus) dan DENV-4 (3 kasus). Hasil ini sesuai dengan penelitian sebelumnya oleh Kumaria 5 di India tahun 2002-2006, dan Chan dkk. 4 di Taiwan tahun 1998-2007 bahwa infeksi DENV-3 menyebabkan manifestasi klinis yang lebih berat dibandingkan dengan serotipe lainnya.…”