title: Serological characterization of dengue virus infections observed among dengue hemorrhagic fever/dengue shock syndrome cases in upper Myanmar.
abstract: In Myanmar, dengue fever (DF)/dengue hemorrhagic fever (DHF) is one of the leading causes of morbidity and mortality among children. From Pyinmana Hospital in 2004 and Mandalay Children Hospital in 2006, 160 patients diagnosed clinically to have DHF/dengue shock syndrome (DSS) were examined for immunoglobulin M (IgM) and IgG levels. A focus reduction neutralization test was also used to determine primary or secondary dengue virus (DENV) infection. By using IgM-capture ELISA, 139 cases were confirmed as DENV infections. Of these IgM-positives, 94 samples were collected 7-24 days from the onset of illness, to which 13 (14%) and 81 (86%) were determined to be primary and secondary DENV infections, respectively. The 13 primary DENV infection cases were spread among the various severity groups (DHF grade I-IV and DSS) and represented age groups ranging from <1 year of age to 9 years of age. The patients in these primary infection cases showed a remarkably high IgM with a low IgG titer response compared with the secondary infection cases. No significant differences were observed in IgG titers with clinical severity. The data obtained in this study suggest that primary DENV infection cases exist certainly among DHF/DSS cases in Myanmar, and that additional mechanism(s) aside from the antibody-dependent enhancement mechanism could have influenced the clinical severity in DHF/DSS cases.
authors.affiliation: Department of Virology, Institute of Tropical Medicine, Nagasaki University and GCOE Program, Nagasaki, Japan.
authors.forename: Mya Myat
authors.initials: MM
authors.lastname: Ngwe Tun
authors.forename: Kyaw Zin
authors.initials: KZ
authors.lastname: Thant
authors.forename: Shingo
authors.initials: S
authors.lastname: Inoue
authors.forename: Yae
authors.initials: Y
authors.lastname: Kurosawa
authors.forename: Yee Yee
authors.initials: YY
authors.lastname: Lwin
authors.forename: Sanda
authors.initials: S
authors.lastname: Lin
authors.forename: Kay Thi
authors.initials: KT
authors.lastname: Aye
authors.forename: Pe
authors.initials: P
authors.lastname: Thet Khin
authors.forename: Tin
authors.initials: T
authors.lastname: Myint
authors.forename: Khin
authors.initials: K
authors.lastname: Htwe
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Mapua
authors.forename: Filipinas F
authors.initials: FF
authors.lastname: Natividad
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirayama
authors.forename: Kouichi
authors.initials: K
authors.lastname: Morita
mesh_terms: D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000276:immunology* / Q000473:pathology*; D003716:Dengue Virus / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008297:Male; D002052:Myanmar; D009500:Neutralization Tests
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: DHF; DSS; dengue virus; primary DENV infection; secondary DENV infection