2003
DOI: 10.1006/viro.2002.1704
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High Levels of Plasma Dengue Viral Load during Defervescence in Patients with Dengue Hemorrhagic Fever: Implications for Pathogenesis

Abstract: Studies of the pathogenesis of dengue hemorrhagic fever (DHF), a potentially life-threatening disease, have revealed the importance of initial high levels of virus replication. However, the possible involvement of virus during the transition from fever to defervescence, a critical stage in determining the severity of disease, has not been appreciated. Using quantitative reverse transcription-polymerase chain reaction, we examined the levels of plasma dengue viral load during both fever and defervescence period… Show more

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Cited by 165 publications
(137 citation statements)
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“…This difference in transmission and subsequent spread had been documented for other dengue virus genotypes (20), but the Southeast Asian genotype remains the only one directly linked to severe disease and displacement of another genotype. Since higher viremias have been associated with DHF (15,19,28,29), these results support the view that Southeast Asian viruses are more pathogenic and that more efficient virus replication in the primary target cells (the immature DCs which reside in the epidermis) provides a selective advantage over viruses of lower pathogenic potential. In the mosquito, infection proceeds through a large variety of cells and organs; our test for dissemination measures the end result of selection in this complex milieu but reflects the virus most probable to be transmitted to other humans.…”
Section: Discussionsupporting
confidence: 67%
“…This difference in transmission and subsequent spread had been documented for other dengue virus genotypes (20), but the Southeast Asian genotype remains the only one directly linked to severe disease and displacement of another genotype. Since higher viremias have been associated with DHF (15,19,28,29), these results support the view that Southeast Asian viruses are more pathogenic and that more efficient virus replication in the primary target cells (the immature DCs which reside in the epidermis) provides a selective advantage over viruses of lower pathogenic potential. In the mosquito, infection proceeds through a large variety of cells and organs; our test for dissemination measures the end result of selection in this complex milieu but reflects the virus most probable to be transmitted to other humans.…”
Section: Discussionsupporting
confidence: 67%
“…Studies that use PCR as an indicator for dengue virus detection show that viremia is higher in DHF versus DF patients. [30][31][32][33] Although antibody-virus complexes and neutralized virus would impact viral biological assays such as viral isolation, they would not likely impact PCR readouts.…”
Section: Discussionmentioning
confidence: 99%
“…In humans, higher viremia is a defining feature of DHF/DSS compared to DF (35,56,57). In particular, DHF/DSS is associated with viremia that is 10-to 100-fold higher in titer than that of DF cases (4).…”
Section: Discussionmentioning
confidence: 99%