title: Elevation in liver enzymes is associated with increased IL-2 and predicts severe outcomes in clinically apparent dengue virus infection.
abstract: The objective of the present study was to assess the circulating TNF-α and IL-2 levels in dengue virus (DENV) infected patients and to correlate these with clinical severity of DENV infections. A single analyte quantitative immunoassay was used to detect TNF-α and IL-2 in 24 dengue fever (DF) and 43 dengue haemorrhagic fever (DHF) patients, 15 healthy adults and 6 typhoid patients. The mean TNF-α and IL-2 levels of DENV- infected patients were higher than that of healthy adults and typhoid patients. No significant difference in TNF-α levels was noted between DF and DHF patients (p=0.5) but a significant increase in IL-2 levels was observed in DHF compared with DF patients (mean of DF=59.7pg/mL, mean of DHF=166.9pg/mL; p=0.02). No significant association of TNF-α or IL-2 levels was noted with packed cell volume (>45), thrombocytopenia, leucopenia or the presence of viraemia. The liver function tests measuring AST (aspartate aminotransferase) (p=0.01) and ALT (alanine aminotransferase) (p=0.02) levels were significantly elevated in DENV-infected patients. AST:ALT was significantly elevated in DHF/DSS (dengue shock syndrome) compared with DF patients. A significant positive linear correlation was noted between AST and IL-2 (r=0.31; p=0.01) and ALT and IL-2 elevations (r=0.2; p=0.02). Thus, AST and ALT levels correlate with both disease severity and circulating IL-2 levels. We suggest a role for circulating IL-2 in liver dysfunction and propose that a combined assessment of AST/ALT in conjunction with IL-2 at the early stages of symptomatic DENV infection may be useful to predict the severe forms of dengue.
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka.
authors.forename: Thamarasi
authors.initials: T
authors.lastname: Senaratne
authors.affiliation: Microbiology and Infectious Diseases, School of Medicine, Flinders University, South Australia, Australia.
authors.forename: Jillian
authors.initials: J
authors.lastname: Carr
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka. Electronic address: faseehan@pdn.ac.lk.
authors.forename: Faseeha
authors.initials: F
authors.lastname: Noordeen
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D003430:Cross-Sectional Studies; D003715:Dengue / Q000097:blood*; D003716:Dengue Virus; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000097:blood*; D008099:Liver / Q000201:enzymology*; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: C508594:IL2 protein, human; D007376:Interleukin-2; D014409:Tumor Necrosis Factor-alpha; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Dengue fever; Dengue haemorrhagic fever; TNF-α and IL-2 levels