title: Characterization of dengue virus infections in a sample of patients suggests unique clinical, immunological, and virological profiles that impact on the diagnosis of dengue and dengue hemorrhagic fever.
abstract: Dengue virus (DENV) infections are increasing with respect to incidence and severity in the Central Province of Sri Lanka. The objective of this study was to define the clinical, immunological, and virological profiles of patients admitted to the General Hospital, Kandy with clinically apparent dengue. Demographic, clinical, hematological parameters, liver enzymes (ALT and AST), and blood samples were collected from 292 patients with fever <5 days post onset and fulfilling the WHO criteria for the diagnosis of dengue fever/dengue hemorrhagic fever (DF/DHF). Samples were analyzed for, anti-DENV IgM, IgG, and DENV nucleic acid. Myalgia was the commonest complaint by 65% of the patients. Packed cell volume was >45% in 27% of the patients while 42.12% had reduced platelets and 62.67% had reduced white blood cell counts. In contrast to other studies, positive tourniquet test (PTT) and petechiae were not major indicators of DENV infection or severity of the disease. Clinical profiles were significantly different between DF and DHF/DSS and showed many similarities to that reported elsewhere. Altogether, 43 patients (14.73%) were viremic as detected by RT-PCR; 181 patients (62%) were positive for anti-DENV IgM, and 245 (84%) patients were positive for anti-DENV IgG. In combination, anti-DENV IgM and RT-PCR assays detected 224 (77.5%) of DENV infected cases, thus improving the DENV diagnosis rate. Hence, the diagnostic utility of PTT, anti-DENV IgM/IgG serology, or RT-PCR used alone in the early phase of illness is low in Sri Lanka but the diagnostic value can be improved by a combination of serology and RT-PCR. J. Med. Virol. 88:1703-1710, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Thamarasi
authors.initials: T
authors.lastname: Senaratne
authors.affiliation: General Hospital, Kandy, Sri Lanka.
authors.forename: Harith
authors.initials: H
authors.lastname: Wimalaratne
authors.affiliation: General Hospital, Kandy, Sri Lanka.
authors.forename: D G S
authors.initials: DG
authors.lastname: Alahakoon
authors.affiliation: General Hospital, Kandy, Sri Lanka.
authors.forename: Nirmali
authors.initials: N
authors.lastname: Gunawardane
authors.affiliation: Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, South Australia.
authors.forename: Jillian
authors.initials: J
authors.lastname: Carr
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Faseeha
authors.initials: F
authors.lastname: Noordeen
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003710:Demography; D003715:Dengue / Q000175:diagnosis* / Q000276:immunology* / Q000503:physiopathology / Q000821:virology; D003716:Dengue Virus / Q000235:genetics / Q000276:immunology; D019353:Endemic Diseases / Q000517:prevention & control / Q000706:statistics & numerical data; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D008297:Male; D063806:Myalgia / Q000821:virology; D011693:Purpura; D012367:RNA, Viral / Q000097:blood; D060888:Real-Time Polymerase Chain Reaction; D019595:Severe Dengue / Q000175:diagnosis* / Q000276:immunology* / Q000503:physiopathology / Q000821:virology; D013188:Sri Lanka / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral
keywords: DENV PCR; Sri Lanka; dengue fever; dengue hemorrhagic fever