title: Laboratory and Molecular Characterization of Dengue Viruses in a 2014 Outbreak in Guangfo Region, Southern China.
abstract: Non-specific symptoms and low viremia levels make early diagnosis of dengue virus (DENV) infection challenging. This study aimed to i) identify laboratory markers that can be used to predict a DENV-positive diagnosis and ii) perform a molecular characterization of DENVs from the 2014 Guangdong epidemic. This retrospective study analyzed 1,044 patients from the Guangdong epidemic who were clinically suspected cases of dengue. Viral RNA was detected by real-time RT-PCR, and viral-specific NS1 antigen was detected using enzyme-linked immuno sorbent assay. A molecular phylogenetic analysis was performed for the with the DENV C-prM gene junction. Patients with dengue infection had leukopenia (2.8 × 109/L), thrombocytopenia (109.0 × 109/L), elevated aspartate aminotransferase (56.0 IU/L) and alanine aminotransferase (43.5 IU/L), and prolonged activated partial thromboplastin time (APTT, 33.5 s) (all P ＜ 0.001) compared to patients without dengue. The positive predictive value of leukopenia and thrombocytopenia for DENV infection were 96.9% and 93.0%, respectively. Leukopenia, thrombocytopenia, elevated aminotransferases, and prolonged APTT were useful predictive markers for an early diagnosis of DENV infection. Phylogenetic analysis indicated that the DENVs from the 2014 epidemic were closely related to a 2010 New Delhi strain and a 2013 Guangzhou strain. The 2014 epidemic consisted of co-circulating DENV-1 genotypes I and V from multiple origins. Efficient dengue surveillance can facilitate rapid response to future outbreaks.
authors.affiliation: Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.|Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
authors.forename: Zhao-Fan
authors.initials: ZF
authors.lastname: Luo
authors.affiliation: Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
authors.forename: Feng-Yi
authors.initials: FY
authors.lastname: Zhang
authors.affiliation: Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.|Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
authors.forename: Xiang-Hua
authors.initials: XH
authors.lastname: Lin
authors.affiliation: Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.|Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Xie
authors.affiliation: Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.|Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
authors.forename: Kun-Yi
authors.initials: KY
authors.lastname: Pan
authors.affiliation: Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.|Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Li
authors.affiliation: The Emergency Technology Research Center of Guangdong Province for Arbovirus Diseases, Center for Disease Control and Prevention of Guangzhou Military Command.
authors.forename: Rui-Wen
authors.initials: RW
authors.lastname: Ren
authors.affiliation: Department of Medical Genetics, Family Planning Research Institute of Guangdong.
authors.forename: Wen-Zhong
authors.initials: WZ
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D019411:Clinical Laboratory Techniques / Q000379:methods; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D003716:Dengue Virus / Q000145:classification* / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D010802:Phylogeny; D011237:Predictive Value of Tests; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D055815:Young Adult
keywords: C-prM gene junction; dengue; diagnosis; phylogenetic tree; predictive markers