Analysis of Clinical and Laboratory Alterations Related to Dengue Case Severity: Comparison between Serotypes 2 and 4 in Brazil

Abstract

The increase in severe dengue (SD) cases has caused great impact on public health and has concerned authorities of countries where the disease is endemic and epidemics reach high proportions. The recognition of progression signs of this severe disease during the initial febrile phase can be difficult, since the symptoms are often indistinguishable from other febrile diseases. The aim of this study was to evaluate the clinical manifestations and laboratory findings in patients from two dengue outbreaks and their association with the disease. The study was conducted in patients ( = 153) with signs and symptoms consistent with dengue occurred during two distinct epidemics, 2010 and 2013, in the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. According to the 2009 World Health Organization criteria, patients were classified as dengue without warning signs ([DwoWS] 60.6%, 57/94), dengue with warning signs ([DwWS] 30.9%, 29/94), and SD (4.25%, 4/94). Patients with DwWS/SD presented lower platelet and leukocyte counts and higher transaminase levels when compared with the DwoWS ones. Interestingly, patients from the epidemic of 2010 caused by dengue virus 2 (DENV-2) had lower platelet counts than patients of the 2013 epidemic caused by DENV-4. Furthermore, plasma leakage, gastrointestinal bleeding, and pleural effusion, hallmarks for a more severe disease, were also more frequently observed in those cases. Although previous studies may have extensively reported the wide range of the clinical aspects of dengue, the characterization of DENV-4 is desirable considering the burden of the disease during epidemics, especially for the health units and hospitals performing patient's management.

Dengue Infection in Children in Fortaleza, Brazil: A 3-Year School-Based Prospective Cohort Study

“… 34 Similarly, a prospective study in central Brazil showed that among 253 cases of laboratory-confirmed dengue that occurred between January 2012 and July 2013, DENV-4 was detected in the 55.6% of cases, DENV-1 in 37.4%, DENV-3 in 5.3%, and DENV-2 in 1.6% of cases. 35 Most children were naive to DENV-4 at the beginning of the study, although there is evidence that some children already had detectable neutralizing antibodies against this serotype at the end of 2011.…”

Renal Injury in DENV-4 Fatal Cases: Viremia, Immune Response and Cytokine Profile

“…In 2012, DENV-4 was prevalent and detected in 63% of the cases reported in Brazil [7]. Despite the highest notification in 2013 (1,452,289 cases), DENV-4 circulation was associated with mild cases [8,9], but severe and fatal cases due to DENV-4 were also reported [10]. Although there has been no definitive association of the different DENV serotypes within the clinical course of the disease, it has been suggested that DENV-2 and DENV-3 are more frequently associated with severe disease [11].…”

Different Profiles of Cytokines, Chemokines and Coagulation Mediators Associated with Severity in Brazilian Patients Infected with Dengue Virus

“…In 2013, the DENV-4 genotype II was the most prevalent serotype [ 10 , 11 ] in an explosive epidemic that caused a high number of cases and deaths, mainly in the states of the southeastern and central-western regions [ 12 , 13 ]. Although the majority of DENV-4 infections were generally characterized by mild clinical pictures compared to other serotypes [ 14 ], severe cases and deaths due to DENV-4 were reported [ 15 ]. Thus, the impact that the re-emergence of DENV-4 had in this endemic country is still not well understood, and studies that include the evaluation of the inflammatory response are necessary.…”