title: Differing influences of virus burden and immune activation on disease severity in secondary dengue-3 virus infections.
abstract: Dengue hemorrhagic fever (DHF), the most severe form of illness following infection with a dengue virus, is characterized by plasma leakage, thrombocytopenia, and hepatic inflammation. The interrelationships among virus burden, immune activation, and development of DHF were examined in 54 children with secondary dengue-3 virus infections participating in a prospective, hospital-based study. DHF was associated with higher mean plasma viremia early in illness and earlier peak plasma interferon-gamma levels. Maximum plasma viremia levels correlated with the degree of plasma leakage and thrombocytopenia. Maximum plasma levels of interleukin (IL)-10 and soluble tumor necrosis factor receptor-II correlated with the degree of thrombocytopenia, independently of viremia levels. Hepatic transaminase elevation correlated with plasma soluble IL-2 receptor levels and not with viremia levels. Quantitative differences in virus burden and host immune responses, and the timing of type 1 cytokine responses, have differing influences on the severity of disease manifestations during secondary dengue-3 virus infections.
authors: Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA 01655, USA. dlibraty@mozart.inet.co.th
authors: Daniel H
authors: DH
authors: Libraty
authors: Timothy P
authors: TP
authors: Endy
authors: Huo-Shu H
authors: HS
authors: Houng
authors: Sharone
authors: S
authors: Green
authors: Siripen
authors: S
authors: Kalayanarooj
authors: Saroj
authors: S
authors: Suntayakorn
authors: Wanya
authors: W
authors: Chansiriwongs
authors: David W
authors: DW
authors: Vaughn
authors: Ananda
authors: A
authors: Nisalak
authors: Francis A
authors: FA
authors: Ennis
authors: Alan L
authors: AL
authors: Rothman
mesh_terms: D015703:Antigens, CD / Q000097:blood; D002648:Child; D018076:DNA, Complementary / Q000032:analysis; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D047889:Receptors, Tumor Necrosis Factor, Type II; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019595:Severe Dengue / Q000276:immunology* / Q000821:virology; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis / Q000276:immunology*
chemical_list: D015703:Antigens, CD; D018076:DNA, Complementary; D018124:Receptors, Tumor Necrosis Factor; D047889:Receptors, Tumor Necrosis Factor, Type II; D016753:Interleukin-10; D007371:Interferon-gamma