title: Dengue viremia titer, antibody response pattern, and virus serotype correlate with disease severity.
abstract: Viremia titers in serial plasma samples from 168 children with acute dengue virus infection who were enrolled in a prospective study at 2 hospitals in Thailand were examined to determine the role of virus load in the pathogenesis of dengue hemorrhagic fever (DHF). The infecting virus serotype was identified for 165 patients (DEN-1, 46 patients; DEN-2, 47 patients; DEN-3, 47 patients, DEN-4, 25 patients). Patients with DEN-2 infections experienced more severe disease than those infected with other serotypes. Eighty-one percent of patients experienced a secondary dengue virus infection that was associated with more severe disease. Viremia titers were determined for 41 DEN-1 and 46 DEN-2 patients. Higher peak titers were associated with increased disease severity for the 31 patients with a peak titer identified (mean titer of 107.6 for those with dengue fever vs. 108.5 for patients with DHF, P=.01). Increased dengue disease severity correlated with high viremia titer, secondary dengue virus infection, and DEN-2 virus type.
authors.affiliation: Department of Virus Diseases, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA. david.vaughn@na.amedd.army.mil
authors.forename: D W
authors.initials: DW
authors.lastname: Vaughn
authors.forename: S
authors.initials: S
authors.lastname: Green
authors.forename: S
authors.initials: S
authors.lastname: Kalayanarooj
authors.forename: B L
authors.initials: BL
authors.lastname: Innis
authors.forename: S
authors.initials: S
authors.lastname: Nimmannitya
authors.forename: S
authors.initials: S
authors.lastname: Suntayakorn
authors.forename: T P
authors.initials: TP
authors.lastname: Endy
authors.forename: B
authors.initials: B
authors.lastname: Raengsakulrach
authors.forename: A L
authors.initials: AL
authors.lastname: Rothman
authors.forename: F A
authors.initials: FA
authors.lastname: Ennis
authors.forename: A
authors.initials: A
authors.lastname: Nisalak
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D003716:Dengue Virus / Q000145:classification* / Q000276:immunology; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D008297:Male; D010996:Pleural Effusion; D012703:Serotyping; D013785:Thailand / Q000453:epidemiology; D014766:Viremia / Q000453:epidemiology / Q000276:immunology / Q000821:virology*
chemical_list: D000914:Antibodies, Viral