Abstract
Despite the increasing numbers of travel-acquired dengue, few studies have assessed virologic markers of the disease in non-endemic populations. We examined the kinetics of diagnostic markers and their associations with clinical parameters in 93 patients with travel-acquired dengue fever. Kinetics analyses suggested a longer average duration for viremia (9 days, CI95%: 8–10) and non-structural protein 1 (NS1) antigenemia (15 days, CI95%: 12–20) than reported in endemic populations. While none of the tests sufficed alone, the best diagnostic coverage was achieved by combining antibody detection with RNA or NS1 testing. Studied by regression models, early relative levels of viremia and NS1 antigenemia proved to be significantly associated with several clinical parameters: high viremia predicted greater likelihood and increased length of hospitalization, the degree of NS1 antigenemia correlated positively with hematocrit and liver transaminases, and both viremia and NS1 antigenemia levels negatively with platelet counts in follow-up. Levels of viremia and NS1 antigenemia may serve as predictors of the clinical manifestations in travel-acquired dengue.
Highlights
Dengue is the most common mosquito-borne viral disease worldwide, causing 50–100 million infections annually [1]
The present study investigated the clinical and diagnostic data of 93 Finnish travelers with acute dengue infections, aiming at (1) describing the kinetics of dengue virus (DENV) viremia, non-structural protein 1 (NS1) antigenemia, and DENV-specific antibodies, (2) assessing their use in diagnostics as combinations, and (3) examining the potential correlation between diagnostic markers and clinical parameters in travel-acquired dengue
Our previous study suggested that the kinetics of DENV viremia and NS1 antigenemia may differ in traveler populations
Summary
Dengue is the most common mosquito-borne viral disease worldwide, causing 50–100 million infections annually [1]. It is endemic in most tropical and subtropical parts of the world, especially in urban areas, many of which are popular travel destinations. The laboratory diagnostics of dengue virus (DENV) infections is currently based on virus isolation, and detection of DENV RNA, non-structural protein 1 (NS1), and DENV-specific antibodies [4,5]. For a rational choice and timing of the tests, the kinetics of the various diagnostic markers needs to be understood. For efficient diagnostics, it appears that two or more methods should be combined
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