title: Dengue serotype-specific differences in clinical manifestation, laboratory parameters and risk of severe disease in adults, singapore.
abstract: Studies on serotype-specific features of dengue and disease severity on adults are limited. We prospectively recruited adult febrile patients without alternate diagnosis to dengue from April 2005 to December 2011. Outcomes were defined using both the World Health Organization (WHO) 1997 and 2009 criteria; Dengue hemorrhagic fever (DHF) and severe dengue (SD). Infecting serotype was identified in 469 dengue-confirmed patients comprising 22.0% dengue virus serotype 1 (DENV-1), 57.1% DENV-2, 17.1% DENV-3, and 3.8% DENV-4. Cases infected with DENV-1 were more likely to present with red eyes whereas presence of joint pain and lower platelet count was associated with DENV-2 cases. After adjusting for potential confounders, DENV-1 was associated with both DHF (adjusted Relative Risk [aRR] = 1.74) and SD (aRR = 2.1) whereas DENV-2 had a lower risk of DHF (aRR = 0.5). DENV-1 genotype 1 and DENV-2 cosmopolitan were the predominant genotypes identified. Infecting dengue serotype and possibly genotype may play an important role in disease severity among adult dengue patients in Singapore.
authors.forename: Chee-Fu
authors.initials: CF
authors.lastname: Yung
authors.forename: Kim-Sung
authors.initials: KS
authors.lastname: Lee
authors.forename: Tun-Linn
authors.initials: TL
authors.lastname: Thein
authors.forename: Li-Kiang
authors.initials: LK
authors.lastname: Tan
authors.forename: Victor C
authors.initials: VC
authors.lastname: Gan
authors.forename: Joshua G X
authors.initials: JGX
authors.lastname: Wong
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
authors.forename: Lee-Ching
authors.initials: LC
authors.lastname: Ng
authors.forename: Yee-Sin
authors.initials: YS
authors.lastname: Leo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood*; D015331:Cohort Studies; D003715:Dengue / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D003716:Dengue Virus / Q000145:classification / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012306:Risk; D065288:Serogroup; D012703:Serotyping; D019595:Severe Dengue / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D013045:Species Specificity; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral
references.citation: Hong Kong Med J. 2008 Jun;14(3):170-7
references.pmid: 18525084
references.citation: Am J Trop Med Hyg. 2003 Feb;68(2):191-202
references.pmid: 12641411
references.citation: Am J Trop Med Hyg. 1988 Jan;38(1):172-80
references.pmid: 3341519
references.citation: J Infect. 2010 Mar;60(3):229-37
references.pmid: 20080126
references.citation: PLoS Negl Trop Dis. 2010;4(7):e766
references.pmid: 20668540
references.citation: PLoS Negl Trop Dis. 2010;4(3):e617
references.pmid: 20209155
references.citation: Am J Trop Med Hyg. 2006 Mar;74(3):449-56
references.pmid: 16525106
references.citation: Arch Med Res. 2006 Aug;37(6):760-73
references.pmid: 16824937
references.citation: Vector Borne Zoonotic Dis. 2010 Dec;10(10):1009-16
references.pmid: 20426686
references.citation: PLoS Negl Trop Dis. 2011;5(5):e1191
references.pmid: 21655307
references.citation: Annu Rev Entomol. 2008;53:273-91
references.pmid: 17803458
references.citation: J Virol. 2003 Apr;77(7):3929-38
references.pmid: 12634353
references.citation: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references.pmid: 15033648
references.citation: Adv Virus Res. 2003;59:315-41
references.pmid: 14696333
references.citation: J Virol. 1999 Jun;73(6):4738-47
references.pmid: 10233934
references.citation: J Infect Dis. 2000 Jan;181(1):2-9
references.pmid: 10608744
references.citation: Virus Res. 2009 Jul;143(1):1-5
references.pmid: 19463715
references.citation: J Clin Microbiol. 2007 Mar;45(3):935-41
references.pmid: 17215345
references.citation: Emerg Infect Dis. 2010 May;16(5):847-9
references.pmid: 20409381
references.citation: J Clin Virol. 2003 May;27(1):1-13
references.pmid: 12727523
references.citation: Western Pac Surveill Response J. 2011 May 20;2(2):24-9
references.pmid: 23908885
references.citation: Int J Infect Dis. 2012 Mar;16(3):e198-203
references.pmid: 22277259
references.citation: Viruses. 2011 Sep;3(9):1562-608
references.pmid: 21994796
references.citation: Infect Genet Evol. 2012 Jan;12(1):77-85
references.pmid: 22036707
references.citation: Braz J Infect Dis. 2010 Mar-Apr;14(2):141-6
references.pmid: 20563439
references.citation: Virology. 1997 Apr 14;230(2):244-51
references.pmid: 9143280
references.citation: Clin Microbiol Rev. 1998 Jul;11(3):480-96
references.pmid: 9665979
references.citation: Am J Trop Med Hyg. 2001 Nov;65(5):427-34
references.pmid: 11716094
references.citation: Bull World Health Organ. 1983;61(4):693-701
references.pmid: 6605216
references.citation: J Gen Virol. 2006 Apr;87(Pt 4):873-83
references.pmid: 16528037
references.citation: J Infect Dis. 2007 Aug 1;196(3):416-24
references.pmid: 17597456
references.citation: Am J Epidemiol. 1984 Nov;120(5):653-69
references.pmid: 6496446
references.citation: J Virol. 2009 May;83(9):4163-73
references.pmid: 19211734
references.citation: PLoS Negl Trop Dis. 2012;6(5):e1638
references.pmid: 22563516
references.citation: Am J Epidemiol. 2000 Nov 1;152(9):793-9; discussion 804
references.pmid: 11085389
references.citation: Ann Acad Med Singapore. 2009 Aug;38(8):667-75
references.pmid: 19736569
references.citation: J Microbiol Immunol Infect. 2009 Dec;42(6):471-8
references.pmid: 20422131