Prevalence of Dengue Serotypes and Its Correlation With the Laboratory Profile at a Tertiary Care Hospital in Northwestern India

Abstract

Background and aimDengue fever is an emerging arboviral public health problem in a large endemic population in the tropical and sub-tropical areas of the world, with varying degrees of clinical presentation. This study was aimed at analyzing the clinical and laboratory dynamics of the four dengue serotypes. MethodsThis institutional review board (IRB)-approved hospital-based observational study was performed with 100 in-patients with dengue infection above 12 years of age, without co-morbidities or known malignancy, in a tertiary care center in Northern India. ResultsOut of 100 patients, four had concurrent infection with two serotypes. Dengue virus serotype-2 (DENV 2) was the most common serotype (34%) and had the maximum percentage of cases of severe dengue (20.6%). The mean total leukocyte count did not differ between the serotypes. DENV 4 had a significantly higher mean neutrophil percentage and a significantly lower mean lymphocyte percentage than DENV 1 (p-value 0.001 and 0.02, respectively), with a higher percentage of cases of severe dengue (20% vs 14.3%, nonsignificant). Thrombocytopenia was present in all serotypes of infection. There was a significant difference in the derangement of liver function in DENV 2, 3, and 4 as compared to DENV 1. Mean serum albumin levels were significantly lower in DENV 3 and 4 infections. Cases with co-infection had a much higher derangement of liver function and lower mean serum albumin than infections with a single serotype. The mean blood urea and creatinine levels were in the normal range for all serotypes. No mortality occurred in our study. ConclusionDENV 2 is the most common serotype with maximum severity at our hospital. DENV 2 and DENV 4 have a high percentage of cases with severe dengue (20.6% and 20%, respectively). The mean lymphocyte percentage was significantly lower while hepatic involvement and hypoalbuminemia were greater in DENV 4. Initial serotyping in patients with dengue can help monitor the epidemiological trends and help estimate the clinical and laboratory trends of the different serotypes of dengue infection. Particular care should be taken in patients with co-infection.

Diagnosis and serotyping of dengue using cost-effective high-resolution melting curve based real time PCR

“…In particular DENV-3 serotype has been found to be associated with severe dengue in many studies (Kalayanarooj and Nimmannitya, 2000;Endy et al, 2002;Nisalak et al, 2003;Kumaria, 2010). In other studies DENV-2 was found to be associated with dengue severity (Vicente et al, 2016;Rajesh et al, 2020;Gupta et al, 2021). Since, both these serotypes, DENV 3 and DENV 2 was prevalently detected in the samples collected in the present study from Karnataka, India, the health care personnel's should be prepared for severe illness if any outbreak ensue in the future.…”

“…One study has reported the absence of link between dengue severity and serotypes (Rao et al, 2020). Few other studies argue that dengue severity is associated with DENV serotype (Vaughn et al, 2000;Kalayanarooj and Nimmannitya, 2000;Endy et al, 2002;Nisalak et al, 2003;Kumaria, 2010;Vicente et al, 2016;Rajesh et al, 2020;Gupta et al, 2021). In particular DENV-3 serotype has been found to be associated with severe dengue in many studies (Kalayanarooj and Nimmannitya, 2000;Endy et al, 2002;Nisalak et al, 2003;Kumaria, 2010).…”

Concurrent dengue infections: Epidemiology & clinical implications

“…Although the first dengue epidemics reported across Asia, Africa and Americas were around the same time, it was in 1789 that Benjamin Rush presented the first case report and coined the term ‘Break Bone fever’ to its symptoms of arthralgia and myalgia 40 43 44 . Only in the 1960s, the serotype-specific epidemiology reports of dengue were available and individual serotypes were introduced serially.…”

“…In addition to the above reports, there have also been many reported incidences of concurrent dengue infections from different parts of India 29 30 31 32 33 34 35 36 37 38 39 40 41 42 . Furthermore, disease severity in an individual has been directly linked to the circulating serotypes and to repeat exposed to different serotypes simultaneously or sequentially.…”

Computational design of immunogenic peptide constructs comprising multiple human leukocyte antigen restricted dengue virus envelope epitopes

“…In India, serological prevalence studies of 2018‐2020 dengue patients have described that DENV‐2 is most prevalent serotype in India and causes severe symptoms (Petechiae, thrombocytopenia etc.) 7,8 …”