title: Dengue epidemics in two distinct periods reveal distinct epidemiological, laboratorial and clinical aspects in a same scenario: analysis of the 2010 and 2013 epidemics in Mato Grosso do Sul, Brazil.
abstract: BACKGROUND
  Dengue is a major problem in Brazil. Epidemiological and clinical aspects were characterized in patients from two epidemics which occurred in Mato Grosso do Sul, Brazil.
  
  
  METHODS
  Dengue cases were classified according to the 2009 WHO criteria, tested by serological and molecular biology tests and analysed for nonstructural protein 1 (NS1) antigenemia.
  
  
  RESULTS
  Dengue was confirmed in 78.7% (48/61) and 75.6% (118/156) of the cases studied in 2010 and 2013, respectively. DENV-1 and DENV-2 were the serotypes involved in the 2010 epidemic and DENV-4 in the 2013 one. Most of the cases were classified as dengue without warning; however, severe dengue was observed in 18.7% (9/48) of the cases in 2010 and less observed in DENV-4 cases. NS1 levels were higher in patients with dengue with warning signs and severe dengue in 2010. Circulating aspartate aminotransferase (AST) and alanine transferase (ALT) were altered in all groups, independently of the infecting serotype or epidemic. Patients with DENV-1 and DENV-2 presented significant lower monocyte counts when compared to patients with DENV-4. An inverse correlation was found between platelet count, leucocytes, monocytes and NS1 levels.
  
  
  CONCLUSIONS
  Epidemics caused by the prevalence of distinct DENV serotypes had different impacts and clinical characteristics in a same scenario and, despite the occurrence of secondary infections, the DENV-4 emergence was not associated with severe cases.
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Nieli Rodrigues da Costa
authors.initials: NR
authors.lastname: Faria
authors.affiliation: Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Victor Edgar Fiestas
authors.initials: VE
authors.lastname: Solorzano
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil.
authors.forename: Rita Maria Ribeiro
authors.initials: RM
authors.lastname: Nogueira
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil.
authors.forename: Thaís
authors.initials: T
authors.lastname: Chouin-Carneiro
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil.
authors.forename: Priscila Conrado Guerra
authors.initials: PC
authors.lastname: Nunes
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil.
authors.forename: Jaqueline Bastos Santos
authors.initials: JB
authors.lastname: Simões
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: de Bruycker Nogueira
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil.
authors.forename: Monique da Rocha Queiroz
authors.initials: Mda R
authors.lastname: Lima
authors.affiliation: Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Luzia Maria
authors.initials: LM
authors.lastname: de Oliveira Pinto
authors.affiliation: Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Claire Fernandes
authors.initials: CF
authors.lastname: Kubelka
authors.affiliation: Medical Clinic Department, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
authors.forename: Rivaldo Venâncio
authors.initials: RV
authors.lastname: da Cunha
authors.affiliation: Imunnology Viral Laboratory Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
authors.forename: Elzinandes Leal
authors.initials: EL
authors.lastname: de Azeredo
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-360, Brazil flaviab@ioc.fiocruz.br.
authors.forename: Flavia Barreto
authors.initials: FB
authors.lastname: dos Santos
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000941:Antigens / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood; D001772:Blood Cell Count; D001938:Brazil / Q000453:epidemiology; D003715:Dengue / Q000097:blood / Q000453:epidemiology* / Q000821:virology; D003716:Dengue Virus / Q000235:genetics; D004797:Enzyme-Linked Immunosorbent Assay; D058872:Epidemics; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D015995:Prevalence; D065288:Serogroup; D012703:Serotyping; D019595:Severe Dengue / Q000097:blood / Q000821:virology; D017361:Viral Nonstructural Proteins / Q000097:blood*
chemical_list: D000941:Antigens; D017361:Viral Nonstructural Proteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Brazil; Clinical aspects; Dengue virus; Diagnosis; Epidemics; NS1