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.
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.
Thomas
Laurent
L
Service des Urgences, Centre Hospitalier Universitaire, Fort-de-France, Martinique. laurent.thomas@chu-fortdefrance.fr
Verlaeten
Olivier
O
Cabié
André
A
Kaidomar
Stéphane
S
Moravie
Victor
V
Martial
Jenny
J
Najioullah
Fatiha
F
Plumelle
Yves
Y
Fonteau
Christiane
C
Dussart
Philippe
P
Césaire
Raymond
R
D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000096:biosynthesis; D003715:Dengue / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology* / Q000821:virology*; D003716:Dengue Virus / Q000145:classification / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008395:Martinique / Q000453:epidemiology; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013045:Species Specificity; D011795:Surveys and Questionnaires; D019562:Viral Load
D000914:Antibodies, Viral