Influence of the Dengue Serotype, Previous Dengue Infection, and Plasma Viral Load on Clinical Presentation and Outcome During a Dengue-2 and Dengue-4 Co-Epidemic

• Published in: The American journal of tropical medicine and hygiene Vol. 78; no. 6; pp. 990 - 998
• Main Authors: Thomas, Laurent, Verlaeten, Olivier, Cabie, Andre, Kaidomar, Stephane, Moravie, Victor, Martial, Jenny, Najioullah, Fatiha, Plumelle, Yves, Fonteau, Christiane, Dussart, Philippe, Cesaire, Raymond
• Format: Journal Article
• Language: English
• Published: Lawrence, KS ASTMH 01.06.2008; Allen Press; American Society of Tropical Medicine and Hygiene
• Subjects: Adult; Aged; Antibodies, Viral; Antibodies, Viral - biosynthesis; Arboviroses; Biological and medical sciences; Dengue; Dengue - epidemiology; Dengue - immunology; Dengue - physiopathology; Dengue - virology; Dengue fevers; Dengue Virus; Dengue Virus - classification; Dengue Virus - isolation & purification; Dengue virus type 2; Emerging diseases; Enzyme-Linked Immunosorbent Assay; Female; Human health and pathology; Human viral diseases; Humans; Infectious diseases; Life Sciences; Male; Martinique; Martinique - epidemiology; Medical sciences; Microbiology and Parasitology; Middle Aged; Reverse Transcriptase Polymerase Chain Reaction; Species Specificity; Surveys and Questionnaires; Tropical viral diseases; Viral diseases; Viral Load; Virology; South America; French Guiana; America; Martinique; Dengue 2; Epidemic; Human; Dengue 4; Prognosis; Dengue; Epidemiology; Blood plasma; Infection; Symptomatology; Viral disease; Arbovirus disease; Evolution; Tropical medicine; Serotype; Viral load; Public health
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.2008.78.990

Martinique experienced a dengue outbreak with co-circulation of DENV-2 and DENV-4. In an emergency department-based study, we analyzed whether the clinical presentation and outcome of adult patients were related to serotype, immune status, or plasma viral load. Of the 146 adult patients who had confirmed dengue infection, 91 (62.3%) were classified as having classic dengue fever, 11 (7.5%) fulfilled World Health Organization criteria for dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), 21 other patients (14.4%) presented with at least one typical feature of DHF/DSS [i.e., internal hemorrhage, plasma leakage, marked thrombocytopenia (platelet count < or = 50,000 platelets/mm(3)) and/or shock], and 23 further patients (15.8%) had unusual manifestations. Four patients died. Severe illness was more frequent in patients with secondary dengue infection (odds ratio, 7.18; 95% confidence interval, 3.1-16.7; P < 0.001). Multivariate regression analysis showed that gastrointestinal symptoms and other unusual manifestations were independently associated with DENV-2 infection, whereas cough and DHF/DSS features were independently associated with secondary immune response. A high plasma viral load was associated with DENV-2 infection, increased serum liver enzymes, and with DHF/DSS features in patients presenting after the third day of illness. The most severe cases of dengue resulted from the combined effects of DENV-2 and secondary infection.