Effect of serotypes on clinical manifestations of dengue fever in adults.
OBJECTIVE
Dengue fever (DF) is a major public health issue. However, it is unclear whether different dengue virus serotypes (DENV) are associated with different clinical manifestations and outcomes. This study investigated the association between viral serotype and clinical manifestations of DF.


METHODS
Adult patients with DENV-2 and DENV-3 who were treated at Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan, from January 1998 to September 2007 were enrolled. The patients' demographic data, underlying diseases, clinical manifestations, laboratory data, and disease outcomes were retrospectively analyzed.


RESULTS
294 patients had DENV-2 and 91 had DENV-3. The median age was 50 years, and 45.7% of patients were men. Patients with DENV-3 were more likely to have a malignancy (p = 0.011), myalgia (p = 0.03), skin rash (p < 0.001), ascites (p = 0.04), and fever (p = 0.003) than patients with DENV-2. Patients with DENV-3 had their lowest levels of white blood cells and platelets, and peak plasma activated partial thromboplastin time (aPTT) 1 day later than patients with DENV-2. DENV-2 infection was associated with a higher monocyte count and more prolonged aPTT early in the clinical course. Infection by DENV-2 more commonly occurred as a secondary infection, while infection by DENV-3 was more common as a primary infection (p < 0.001). There were no differences between the groups in organ involvement, disease severity, duration of hospital stay, and medical expenditure.


CONCLUSIONS
The symptoms, signs, and laboratory findings appear to be different for patients infected with DENV-2 and DENV-3, but there is no difference in outcomes.
Tsai
Jih Jin
JJ
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. jijits@cc.kmu.edu.tw
Chan
Kah Sieong
KS
Chang
Jung San
JS
Chang
Ko
K
Lin
Chien Chou
CC
Huang
Jyh Hsiung
JH
Lin
Wei Ru
WR
Chen
Tun Chieh
TC
Hsieh
Hsiao Chen
HC
Lin
Shu Hui
SH
Lin
Ju Chuen
JC
Lu
Po Liang
PL
Chen
Yen Hsu
YH
Lin
Chun Yu
CY
D016009:Chi-Square Distribution; D003715:Dengue / Q000145:classification / Q000473:pathology / Q000821:virology*; D003716:Dengue Virus / Q000472:pathogenicity*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D012189:Retrospective Studies; D012703:Serotyping; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013624:Taiwan