title: Slower rates of clearance of viral load and virus-containing immune complexes in patients with dengue hemorrhagic fever.
abstract: BACKGROUND
  Although previous studies have revealed the contribution of an initial high level of dengue virus replication to the severe and potentially life-threatening diseases dengue hemorrhagic fever (DHF) and dengue shock syndrome, the involvement of dengue virus in the immunopathological processes during the transition from fever to defervescence, which is a critical stage in determining the progression to DHF, has not been appreciated. Previously, we reported that dengue virus can be detected in the immune complexes of patients with DHF during this period.
  
  
  METHODS
  We investigated plasma dengue viral load, virus in immune complexes, antibody response, complements, and cytokines for 54 patients with dengue fever (a relatively mild form of disease) and 49 patients with DHF. The patients had confirmed secondary infection with dengue virus type 2 from a large outbreak in southern Taiwan in 2002.
  
  
  RESULTS
  Patients with DHF had a significantly higher viral load and a slower rate of clearance than patients with dengue fever. For viral loads >5.7 log RNA copies/mL on the day of defervescence, the positive and negative predictive values for DHF are 0.88 and 0.95, respectively. A higher level and slower decline of dengue virus-containing immune complexes (and a subsequently higher elevation of C5a and soluble interleukin 2 receptor) were found in patients with DHF, compared with patients with dengue fever.
  
  
  CONCLUSIONS
  These findings indicate that slower rates of clearance of viral load and virus-containing immune complexes are associated with subsequent immune activation and contribute to the progression of DHF at this critical stage. Moreover, viral load on the day of defervescence can predict cases of DHF.
authors.affiliation: Institute of Microbiology, College of Medicine, National Taiwan University, Taipei, 100, Taiwan. wwang60@yahoo.com
authors.forename: Wei-Kung
authors.initials: WK
authors.lastname: Wang
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Chao-Fu
authors.initials: CF
authors.lastname: Yang
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Hsieh
authors.forename: Chung-Chou
authors.initials: CC
authors.lastname: Juan
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Chang
authors.forename: Cheng-Ching
authors.initials: CC
authors.lastname: Yu
authors.forename: Li-Hui
authors.initials: LH
authors.lastname: Lin
authors.forename: Jyh-Hsiung
authors.initials: JH
authors.lastname: Huang
authors.forename: Chwan-Chuen
authors.initials: CC
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000936:Antigen-Antibody Complex / Q000097:blood*; D003715:Dengue / Q000276:immunology / Q000821:virology; D003716:Dengue Virus / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019595:Severe Dengue / Q000276:immunology / Q000821:virology*; D018709:Statistics, Nonparametric; D019562:Viral Load
chemical_list: D000936:Antigen-Antibody Complex