Disease Exacerbation Caused by Sequential Dengue Infections: Myth or Reality?

Rosen, Léon

doi:10.1093/clinids/11.supplement_4.s840

Cited by 41 publications

(14 citation statements)

References 14 publications

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“…7 The occurrence of DHF in primary infections could be related to viral strain and serotype; dengue viral virulence has long been proposed as an alternative to the immune enhancement hypothesis. [35][36][37] Interestingly, other studies have found that DEN-3 causes DHF in primary infections to a greater extent than DEN-2 or DEN-4. 28,33 It has been hy-pothesized that determinants for primary disease severity may be different from those associated with severe disease in secondary infections.…”

Section: Discussionmentioning

confidence: 99%

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Harris¹,

Videa²,

Pérez³

et al. 2000

Am J Trop Med Hyg

261

206

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Abstract. From July to December 1998, a hospital-and health center-based surveillance system for dengue was established at selected sites in Nicaragua to better define the epidemiology of this disease. Demographic and clinical information as well as clinical laboratory results were obtained, and virus isolation, reverse transcriptase-polymerase chain reaction, and serologic assays were performed. World Health Organization criteria were used to classify disease severity; however, a number of patients presented with signs of shock in the absence of thrombocytopenia or hemoconcentration. Therefore, a new category was designated as ''dengue with signs associated with shock'' (DSAS). Of 1,027 patients enrolled in the study, 614 (60%) were laboratory-confirmed as positive cases; of these, 268 (44%) were classified as dengue fever (DF); 267 (43%) as DF with hemorrhagic manifestations (DFHem); 40 (7%) as dengue hemorrhagic fever (DHF); 20 (3%) as dengue shock syndrome (DSS); and 17 (3%) as DSAS. Interestingly, secondary infection was not significantly correlated with DHF/DSS, in contrast to previous studies in Southeast Asia. DEN-3 was responsible for the majority of cases, with a minority due to DEN-2; both serotypes contributed to severe disease. As evidenced by the analysis of this epidemic, the epidemiology of dengue can differ according to geographic region and viral serotype.

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Section: Discussionmentioning

confidence: 99%

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Harris¹,

Videa²,

Pérez³

et al. 2000

Am J Trop Med Hyg

261

206

View full text Add to dashboard Cite

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“…The DENV-3 Sri Lankan genotype IIIb strain was later introduced and which also caused DHF/DSS throughout the Americas [1], but virulent (DHF/DSS-associated) DENV-3 Asian I and V genotype strains were also isolated in South America [19,20]. While most cases of SDD (DHF/DSS) were previously associated with secondary DENV infections [9], many patients with primary infections, particularly with DENV-1 strains, also developed DHF/DSS [21]. More recently, there have been many reports in which patients with primary DENV infections developed SDD (DHF/DSS) in: 1) Thailand (primary DHF: 13.2%) [22], and which were predominantly caused by DENV-1 and DENV-3 serotypes (primary DHF: DENV-1: 20%, DENV-3: 21%) [23] (primary DHF: DENV-1: 28%, DENV-3: 33%) [24]; 2) Viet Nam, mainly caused by DENV-1 compared with DENV-2 (primary DHF: 18%) [25]; 3) Colombia, mainly by DENV-3, but less so by DENV-2 [26]; 4) Brazil, predominantly by DENV-3 (primary DHF: 42.7%) [27] (primary DHF: 55.2%) [28].…”

Section: Introductionmentioning

confidence: 99%

Simple Prognostic Criteria Can Definitively Identify Patients Who Develop Severe Versus Non-Severe Dengue Disease, or Have Other Febrile Illnesses

Falconar

Romero-Vivas

2012

J Clin Med Res

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BackgroundSevere dengue disease (SDD) (DHF/DSS: dengue hemorrhagic fever/dengue shock syndrome) results from either primary or secondary dengue virus (DENV) infections, which occur 4 - 6 days after the onset of fever. As yet, there are no definitive clinical or hematological criteria that can specifically identify SDD patients during the early acute febrile-phase of disease (day 0 - 3: < 72 hours). This study was performed during a SDD (DHF/DSS) epidemic to: 1) identify the DENV serotypes that caused SDD during primary or secondary DENV infections; 2) identify simple clinical and hematological criteria that could significantly discriminate between patients who subsequently developed SDD versus non-SDD (N-SDD), or had a non-DENV fever of unknown origin (FUO) during day 0 - 3 of fever; 3) assess whether DENV serotype co-infections resulted in SDD.MethodsFirst serum samples, with clinical and hematological criteria, were collected from 100 patients during the early acute febrile-phase (day 0 - 3: < 72 hours), assessed for DENV or FUO infections by IgM- and IgG-capture ELISAs on paired serum samples and by DENV isolations, and subsequently graded as SDD, N-SDD or FUO patients.ResultsIn this study: 1) Thirty-three patients had DENV infections, predominantly secondary DENV-2 infections, including each SDD (DHF/DSS) case; 2) Secondary DENV-2/-3 and DENV-2/-4 serotype co-infections however resulted in N-SDD; 3) Each patient who subsequently developed SDD, but none of the others, displayed three clinical criteria: abdominal pain, conjunctival injection and veni-puncture bleeding, therefore each of these criteria provided definitively significant prognostic (P < 0.001) values; 4) Petechia, positive tourniquet tests and hepatomegaly, and neutrophilia or leukopenia also significantly identified those who: a) subsequently developed SDD versus N-SDD, or had a FUO; b) subsequently developed SDD versus N-SDD; c) subsequently developed N-SDD versus FUOs, respectively.ConclusionsThis is the first report of simple definitively prognostic criteria for SDD patients, including the first assessment and confirmation of conjunctival injection. The three definitive clinical criteria used alone, or supported by the other four criteria, could be essential for specifically identifying those patients needing prompt hospital-based therapies to lessen or avert SDD, without unnecessary hospitalization of the other patients.KeywordsDengue virus; Severe dengue; Dengue fever; Diagnostic; Criteria; Hemorrhage; Shock

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“…This hypothesis is termed antibody-dependent enhancement (ADE). Differences in virus virulence, however, have also been postulated to be the primary risk factor in severe forms of the disease [Rosen, 1989;Murgue et al, 1997Murgue et al, , 1998Deparis et al, 1998a].…”

Section: Introductionmentioning

confidence: 99%

Prospective study of the duration and magnitude of viraemia in children hospitalised during the 1996-1997 dengue-2 outbreak in French Polynesia

et al. 2000

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The magnitude and duration of viraemia in children admitted to the hospital with dengue was studied during a dengue 2 outbreak in French Polynesia in 1996-1997. Forty-nine patients from whom at least 3 plasma samples were available were included in the study. Based on analysis of IgG-ELISA and haemagglutination inhibition assay, 21 of these were primary and 28 were secondary infections. According to World Health Organization criteria, 42 were dengue fever and 7 were dengue haemorrhagic fever. Virus was detectable by reverse transcription-PCR in all patients for at least the first 3 days of the onset of fever, but was never detected after the 6th day (mean duration = 4.4 days). Plasma virus titers ranged from 1.7-5.6 Log(10) TCID(50)/ml. A significant difference was not observed in the magnitude and duration of viraemia in patients with primary versus secondary infections. The severity of the illness, however, was correlated with both criteria.

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Disease Exacerbation Caused by Sequential Dengue Infections: Myth or Reality?

Cited by 41 publications

References 14 publications

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Simple Prognostic Criteria Can Definitively Identify Patients Who Develop Severe Versus Non-Severe Dengue Disease, or Have Other Febrile Illnesses

Prospective study of the duration and magnitude of viraemia in children hospitalised during the 1996-1997 dengue-2 outbreak in French Polynesia

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