title: Co-circulating serotypes in a dengue fever outbreak: Differential hematological profiles and phylogenetic relationships among viruses.
abstract: Dengue virus, represented by four distinct, genetically diverse serotypes, is the etiologic agent of asymptomatic to severe hemorrhagic diseases. The spatiotemporal dynamics of dengue serotypes and its association to specific diseases vary among the different regions worldwide. By 2007, and in São Paulo State, Brazil, dengue-case concentration in urban centers had changed to increased incidence in small- and medium-sized towns, the case of Marília.
  
  
  
  The aim of this article was to distinguish dengue serotypes circulating during the 2007 Marília outbreak and define their association to demographic and hematological patient profiles, as well as the phylogenetic relationships among the different viruses.
  
  
  
  PCR amplicons corresponding to the junction of capsid and dengue pre-membrane encoding genes, obtained from dengue serologically positive patients, were sequenced. Hematological and demographic data of patients with different Dengue serotypes were evaluated by univariate and bivariate statistics. Dengue PCR sequences were used in phylogenetic relationships analyzed for maximum parsimony.
  
  
  
  Molecular typing confirmed co-circulation of the dengue serotypes 1 (DENV1) and 3 (DENV3), which presented divergent correlation patterns with regard to hematological descriptors. The increase in atypical lymphocytes, a likely indication of virus load, could be significantly associated to a decrease in leukocyte counts in the DENV3 group and platelet in the DENV1. Phylogenetic reconstitution revealed the introduction of DENV1 from northern Brazil and local divergence of DENV3 by either microevolution or viral introduction from other geographical regions or both.
  
  
  
  Dengue dynamics showed regional molecular-epidemiologic specificity, which has important implications for introduction of vaccines, disease management, and transmission control.
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil; Secretaria do Estado da Saúde do Estado de São Paulo, Instituto Adolfo Lutz, Centro de Laboratório Regional VIII, Santo André, 09040-160 São Paulo, Brazil.
authors.forename: Andreia Moreira Dos Santos
authors.initials: AM
authors.lastname: Carmo
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil; Discipline of Parasitology, Marília Medical School, Marília, 17519-030, São Paulo, Brazil.
authors.forename: Rodrigo Buzinaro
authors.initials: RB
authors.lastname: Suzuki
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil.
authors.forename: Aline Diniz
authors.initials: AD
authors.lastname: Cabral
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil.
authors.forename: Renata Torres da
authors.initials: RT
authors.lastname: Costa
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil.
authors.forename: Gabriela Pena
authors.initials: GP
authors.lastname: Massari
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil.
authors.forename: Michele Marcondes
authors.initials: MM
authors.lastname: Riquena
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil.
authors.forename: Helio Augusto Alves
authors.initials: HA
authors.lastname: Fracasso
authors.affiliation: Universidade Federal do ABC, Centro de Ciências Naturais e Humanas, Santo André, 09210-170 São Paulo, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Eterovic
authors.affiliation: Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária, Universidade de São Paulo, 05508-270 São Paulo, Brazil; Universidade de Santo Amaro, 04829-300 São Paulo, Brazil.
authors.forename: Arlei
authors.initials: A
authors.lastname: Marcili
authors.affiliation: Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Bernardo do Campo, 09606-070 São Paulo, Brazil. Electronic address: marcia.speranca@ufabc.edu.br.
authors.forename: Márcia Aparecida
authors.initials: MA
authors.lastname: Sperança
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001773:Blood Cells / Q000473:pathology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D016000:Cluster Analysis; D003715:Dengue / Q000453:epidemiology* / Q000821:virology*; D003716:Dengue Virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D065288:Serogroup; D055815:Young Adult
keywords: dengue; genotype sequence analysis; hematological profile; molecular epidemiology; pattern of dengue outbreak; phylogeny