Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases

Souza, Luíz José de; Alves, José Galvão; Nogueira, Rita Maria Ribeiro; Neto, Carlos Gicovate; Bastos, Diogo Assed; Siqueira, Edno Wallace da Silva; Filho, João Tadeu Damian Souto; Cezário, Thiago de Abreu; Soares, Carlos Eduardo Cordeiro; Carneiro, Rodrigo da Costa

doi:10.1590/s1413-86702004000200006

Cited by 171 publications

(139 citation statements)

References 16 publications

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“…; this finding is similar to human cases where the peak levels of transaminases ocurred normally at the 7th day p.i. also, and decreased during the following two weeks (Kuo et al 1992, Souza et al 2004.…”

Section: Discussionmentioning

confidence: 87%

“…Abnormal levels of AST and ALT were observed in patients with DEN infection. Often the DF is associated with mild to moderate elevations of such enzymes, while in patients with DHF/DSS, the AST and AST levels became remarkable higher (Kuo et al 1992, Souza et al 2004). In our experimental mouse model we observed peak levels of both hepatic transaminases (AST/ALT) at the 7th day p.i.…”

Section: Discussionmentioning

confidence: 99%

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Morphological studies in a model for dengue-2 virus infection in mice

Barth

Barreto²,

Paes

et al. 2006

Mem. Inst. Oswaldo Cruz

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One of the main difficulties in studying dengue virus infection in humans and in developing a vaccine is the absence of a suitable animal model which develops the full spectrum of dengue fever, dengue haemorrhagic fever, and dengue shock syndrome. It is our proposal to present morphological aspects of an animal model which shows many similarities with the dengue infection in humans. BALB/c mice were intraperitoneally infected with non-neuroadapted dengue virus serotype 2 (DENV-2). Histopathological and morphometrical analyses of liver tissue revealed focal alterations along the infection, reaching wide-ranging portal and centrolobular veins congestion and sinusoidal cell death. Additional ultrastructural observations demonstrated multifocal endothelial injury, platelet recruitment, and alterated hepatocytes. Dengue virus antigen was detected in hepatocytes and in the capillar endothelium of the central lobular vein area. Liver function tests showed high levels of aspartate transaminase and alanine transaminase enzyme activity. Lung tissue showed interstitial pneumonia and mononuclear cells, interseptal oedema, hyperplasia, and hypertrophy of the bronchiolar epithelial cells. DENV-2 led to a transient inflammatory process, but caused focal alterations of the blood-exchange barrier. Viremia was observed from 2nd to 11th day p.i. by isolation of DENV-2 in C6/36 mosquito cell line inoculated with the supernatant of macerated liver, lung, kidney, and cerebellum tissues of the infected mice.Key words: dengue-2 virus -BALB/c mice -liver -viremia -ultrastructure -histopathology Dengue viruses (DENV) are mosquito-borne RNAviruses that are classified serologically into four antigenically distinct types (DENV-1, 2, 3, 4). They infect millions of people in tropical and subtropical regions of the world and may cause a mild to debilitating febrile illness, the classical dengue fever (DF), the dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS). However, the pathogenesis of human dengue infection (DEN) remains not sufficiently known, and no successful vaccine is available as yet (Eckels 1993). The studies on pathogenesis, pharmacodynamics, and prophylaxis of DHF have been hampered due to the lack of a suitable animal model (Bhamarapravati 1993).DENV have been inoculated into numerous species of animals by a variety of routes. Studies on laboratory mice and non-human primates remain the most wellcharacterized models (Cole & Wisseman 1969, Marchette et al. 1973, Boonpucknavig et al. 1981, Hotta et al. 1981a,b, Chaturvedi et al. 1991, Wu et al. 1995.Several studies indicated that mice are a permissive host for DENV (Meiklejhon et al. 1952, Lin et al. 1998, Johnson & Roehrig 1999. However, no infectious model that mimics DHF/DSS has yet been reported (Huang et al. 2000). Until now the great majority of mice models of DENV infection deal with suckling or young mice infected by an intracerebral route of inoculation (Nath et al. 1983, Raut et al. 1996 and with mouse-neuroadapted DENV (Desprès et al. 1998, Atrasheuskaya e...

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Morphological studies in a model for dengue-2 virus infection in mice

Barth

Barreto²,

Paes

et al. 2006

Mem. Inst. Oswaldo Cruz

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“…The extent to which the liver is affected by DENV ranges from mild lesions to fulminant hepatitis [5,[9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study [5], the liver was found to be affected in around 60% of cases according to a rapid strip test. In the present study, the enzymatic method was used during an epidemic of dengue in the municipality of Campos dos Goytacazes in 2003.…”

mentioning

confidence: 85%

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The impact of dengue on liver function as evaluated by aminotransferase levels

Souza¹,

Nogueira²,

Soares³

et al. 2007

Braz J Infect Dis

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The objective of this study was to evaluate the impact of dengue virus infection on liver function by measuring aminotransferase in blood samples from patients serologically diagnosed by according to two MAC-ELISA protocols. Degrees of liver damage were classified according to aminotransferase levels: grade A -normal enzyme levels; grade B -increased levels of at least one of the enzymes; grade C -increased, with at least one of the enzymes being at levels higher than three times the upper reference values; grade D -acute hepatitis, with aminotransferase levels at least ten times their normal values. Of the 169 serologically confirmed cases of dengue at the dengue referral center in Campos dos Goytacazes in the state of Rio de Janeiro, Brazil, 65.1% had abnormal aminotransferase levels: 81 cases being classified as grade B, 25 as grade C and 3 as grade D. A further 34.9% of cases had normal enzyme levels and were classified as grade A. Liver damage is a common complication of dengue infection and aminotransferase levels are a valuable marker for monitoring these cases.

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Prediction of severity of dengue infection in children based on hepatic involvement

Alam,

Fathema,

Yasmin

et al. 2024

JGH Open

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Background and AimTo assess the spectrum of hepatic involvement in children with dengue fever (DF) and prediction of severity of dengue infection by early detection of elevated liver enzymes.MethodsThis prospective observational study was conducted at a tertiary care hospital from June 2019 to September 2019. Children admitted with DF were included. Severity of DF was graded as dengue without warning sign (DNWS), with warning sign (DWS), and severe dengue fever (SDF) according to WHO criteria. Liver injury (LI) was defined as alanine aminotransferase (ALT) more than upper limit of normal irrespective of sex.ResultsOf 190 children (male, 109) with DF, 60 had DNWS, 49 had DWS, and 81 had SDF. A total of 100 children (52.6%) had LI. The distribution of hepatic involvement spectrum involves hepatomegaly (26.3%), hepatic tenderness (25.2%), features of acute liver failure (1.5%), raised level of ALT (52.6%), raised level of aspartateaminotransferase (AST) (65.8%), prolonged prothrombin time (7.3%), and reduced level of serum albumin (44.7%) in children. Of them, 5.8% and 6.8% of children had >tenfold increase in ALT and AST values. The degree of liver function derangement significantly (P < 0.05) increased with DF severity. In our study, ALT at 422 IU/L (10 times upper limit of normal [ULN]) and AST 689 IU/L (17 times ULN) had similar sensitivity and specificity as WHO recommended cutoff of 1000 IU/L (25 times of ULN) to detect SDF.ConclusionALT ≥10 times and AST ≥17 times of ULN are as sensitive as ≥25 times (as recommended by WHO) to detect SDF.

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Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases

Cited by 171 publications

References 16 publications

Morphological studies in a model for dengue-2 virus infection in mice

Morphological studies in a model for dengue-2 virus infection in mice

The impact of dengue on liver function as evaluated by aminotransferase levels

Prediction of severity of dengue infection in children based on hepatic involvement

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