title: Both viremia and cytokine levels associate with the lack of severe disease in secondary dengue 1 infection among adult Chinese patients.
abstract: Secondary dengue infections are frequently associated with increased risk for dengue hemorrhagic fever and dengue shock syndrome. Surprisingly, we observed no dengue hemorrhagic fever cases among 353 hospitalized dengue-infected patients including 212 with primary, and 141 with secondary dengue 1 infection in China. To explore virological and immunological mechanisms which may account for this unexpected clinical observation, we assessed dengue viremia, type I interferon and inflammatory cytokine levels in these patients. While the levels of viremia and inflammatory cytokines are indistinguishable between primary and secondary infections, IFNα levels are significantly higher in primary than that in secondary infection. However, IFNα levels are positively correlated with dengue viremia levels (p<0.0001), but negatively correlated with the platelet counts (p<0.0001) and serum ALT levels (p = 0.0003). These results provide direct in vivo evidence that clinical dengue disease severity is affected by both viral and human immune factors.
authors.affiliation: Department of Laboratory Medicine, Guangzhou 8th People's Hospital, Guangzhou Medical College, Guangzhou, China.
authors.forename: Yangbo
authors.initials: Y
authors.lastname: Tang
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Kou
authors.forename: Fuchun
authors.initials: F
authors.lastname: Zhang
authors.forename: Xian
authors.initials: X
authors.lastname: Yao
authors.forename: Shengyong
authors.initials: S
authors.lastname: Liu
authors.forename: Jingming
authors.initials: J
authors.lastname: Ma
authors.forename: Yusen
authors.initials: Y
authors.lastname: Zhou
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Tang
authors.forename: Xia
authors.initials: X
authors.lastname: Jin
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002681:China; D015331:Cohort Studies; D016207:Cytokines / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016898:Interferon-alpha / Q000378:metabolism; D007371:Interferon-gamma / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D012367:RNA, Viral / Q000378:metabolism; D019595:Severe Dengue / Q000097:blood / Q000150:complications* / Q000821:virology*; D014766:Viremia / Q000473:pathology*
chemical_list: D016207:Cytokines; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016898:Interferon-alpha; D012367:RNA, Viral; D016753:Interleukin-10; D007371:Interferon-gamma; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase