The association between dengue viremia kinetics and dengue severity: A systemic review and meta‐analysis

Abstract

In this study, we aim to assess the association of dengue viremia with dengue severity. The study protocol was developed and registered in PROSPERO (CRD42016039864). We searched nine databases to find potential papers. Studies meeting the inclusion criteria were included. We, based our analysis on three outcomes which are disease severity, dengue serotype and disease infection type. Thirty studies with 3316 patients were included. Our analysis revealed that viremia is significantly higher in dengue hemorrhagic fever patients than dengue fever in days 5 to 6. Regarding the serotype of dengue, the maximum viremia titre of serotype 1 was significantly higher than serotype 3 and the viremia in dengue serotype 2 was significantly higher than serotype 4 in days 2 to 4. However, comparison of the daily viremia level between the primary and secondary dengue infection revealed that secondary infection was

Stochastic Model of the Adaptive Immune Response Predicts Disease Severity and Captures Enhanced Cross-Reactivity in Natural Dengue Infections

“…For both secondary viral peak maximum and concentration of naïve B cells, the centroids of these four clusters presented a clear and significant separation of disease severity based on their p-values (<0.05). This method of correlation disease severity with the secondary viral titers is also supported by a recent systematic review of 30 studies with 3,316 patients, which revealed that viremia is significantly higher in DHF patients than those in DF patients in days 5 to 6 when peaked viremia were reached (38).…”

Antibody-dependent enhancement representing in vitro infective progeny virus titer correlates with the viremia level in dengue patients

“…A previous study showed that ADE contributed to an increase in viremia in an animal model 39 . High viremia levels in dengue patients have also been reported to correlate with disease severity 6 , 9 – 13 , although the significance of the correlation is dependent on the disease day 14 . Since the viremia in humans is caused by secretion of the progeny viruses from the infected-host cells, the viral titers in the supernatant obtained from the in vitro NAb/EAb-balance assay might correlate to the clinical viral load.…”

“…Although a mechanism associated with the severity and a surrogate marker predicting the deterioration have not been fully identified yet, high levels of viremia have been shown to be related to disease severity 6 , 9 – 13 . Moreover, a recently published meta-analysis revealed that there was an association between disease severity and viremia duration 14 . On the other hand, some studies have reported finding no association between disease severity and high viremia levels 15 , 16 .…”

Decreased Type I Interferon Production by Plasmacytoid Dendritic Cells Contributes to Severe Dengue

“…77% of DHF and DSS patients encountered a secondary infection while infection status could not be determined for 23% of the patients ( Figure 1B). As viremia is dependent on immune status, infecting serotype, day of fever and possibly comorbidities, we observe a wide variability in viral load in children with DF and DHF/DSS (36,37). As frequencies of immune cells and the immune response can vary from day to day during acute DENV infection (38), it is important to emphasize that not only were all patients recruited within 96 h of fever onset, there was no difference in day of fever at inclusion between DF and DHF/DSS patients ( Table 1).…”