title: 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 periods in patients from a DEN-3 outbreak in southern Taiwan in 1998. Higher levels of plasma dengue viral RNA were found in DHF patients than in DF patients. During defervescence, while the level of plasma dengue viral RNA was undetectable in most DF patients, it remains high in all DHF patients. Using a modified immunoprecipitation assay, we demonstrated for the first time that the plasma dengue viruses persisting during defervescence were in the immune complexes for most DHF patients. These findings suggest that continued active viral replication or delay in the clearance of viremia contributes to the pathogenesis of DHF. Moreover, high levels of plasma dengue viral RNA during defervescence may serve as a disease marker for DHF.
authors.affiliation: Institute of Microbiology, College of Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. wwang60@yahoo.com
authors.forename: Wei-Kung
authors.initials: WK
authors.lastname: Wang
authors.forename: Day-Yu
authors.initials: DY
authors.lastname: Chao
authors.forename: Chuan-Liang
authors.initials: CL
authors.lastname: Kao
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Wu
authors.forename: Yung-Ching
authors.initials: YC
authors.lastname: Liu
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Li
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Lin
authors.forename: Shih-Ting
authors.initials: ST
authors.lastname: Ho
authors.forename: Jyh-Hsiung
authors.initials: JH
authors.lastname: Huang
authors.forename: Chwan-Chuen
authors.initials: CC
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000936:Antigen-Antibody Complex; D003716:Dengue Virus / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019595:Severe Dengue / Q000821:virology*; D019562:Viral Load; D014766:Viremia / Q000821:virology*
chemical_list: D000936:Antigen-Antibody Complex; D012367:RNA, Viral