title: Dengue viral RNA levels in peripheral blood mononuclear cells are associated with disease severity and preexisting dengue immune status.
abstract: BACKGROUND
  Infection with dengue viruses (DENV) causes a wide range of manifestations from asymptomatic infection to a febrile illness called dengue fever (DF), to dengue hemorrhagic fever (DHF). The in vivo targets of DENV and the relation between the viral burden in these cells and disease severity are not known.
  
  
  METHODS
  The levels of positive and negative strand viral RNA in peripheral blood monocytes, T/NK cells, and B cells and in plasma of DF and DHF cases were measured by quantitative RT-PCR.
  
  
  RESULTS
  Positive strand viral RNA was detected in monocytes, T/NK cells and B cells with the highest amounts found in B cells. Viral RNA levels in CD14+ cells and plasma were significantly higher in DHF compared to DF, and in cases with a secondary infection compared to those undergoing a primary infection. The distribution of viral RNA among cell subpopulations was similar in DF and DHF cases. Small amounts of negative strand RNA were found in a few cases only. The severity of plasma leakage correlated with viral RNA levels in plasma and in CD14+ cells.
  
  
  CONCLUSIONS
  B cells were the principal cells containing DENV RNA in peripheral blood, but overall there was little active DENV RNA replication detectable in peripheral blood mononuclear cells (PBMC). Secondary infection and DHF were associated with higher viral burden in PBMC populations, especially CD14+ monocytes, suggesting that viral infection of these cells may be involved in disease pathogenesis.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America. anon.srikiatkhachorn@umassmed.edu
authors.forename: Anon
authors.initials: A
authors.lastname: Srikiatkhachorn
authors.forename: Sineewanlaya
authors.initials: S
authors.lastname: Wichit
authors.forename: Robert V
authors.initials: RV
authors.lastname: Gibbons
authors.forename: Sharone
authors.initials: S
authors.lastname: Green
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Libraty
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Endy
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ennis
authors.forename: Siripen
authors.initials: S
authors.lastname: Kalayanarooj
authors.forename: Alan L
authors.initials: AL
authors.lastname: Rothman
mesh_terms: D000704:Analysis of Variance; D002648:Child; D003715:Dengue / Q000097:blood* / Q000276:immunology*; D003716:Dengue Virus / Q000276:immunology* / Q000502:physiology*; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000821:virology*; D008297:Male; D012367:RNA, Viral / Q000097:blood*
chemical_list: D012367:RNA, Viral