Abstract
Dengue is a worldwide problem characterized by a multifactorial pathogenesis. Considering the viral components, it is known that high viremia or high levels of the secreted nonstructural protein 1 (NS1) may be associated with a more severe disease. We aimed to characterize the NS1 antigenemia and viremia in dengue fatal and non-fatal cases, as potential markers of progression to a fatal outcome. NS1 antigenemia and viremia were determined in Brazilian dengue fatal cases (n = 40) and non-fatal cases (n = 40), representative of the four dengue virus (DENV) serotypes. Overall, the fatal cases presented higher NS1 levels and viremia. Moreover, the fatal cases from secondary infections showed significantly higher NS1 levels than the non-fatal ones. Here, irrespective of the disease outcome, DENV-1 cases presented higher NS1 levels than the other serotypes. However, DENV-2 and DENV-4 fatal cases had higher NS1 antigenemia than the non-fatal cases with the same serotype. The viremia in the fatal cases was higher than in the non-fatal ones, with DENV-3 and DENV-4 presenting higher viral loads. Viral components, such as NS1 and viral RNA, may be factors influencing the disease outcome. However, the host immune status, comorbidities, and access to adequate medical support cannot be ruled out as interfering in the disease outcome.
Highlights
The incidence of dengue has increased dramatically around the world in recent decades, and an estimated 50–100 million cases occur annually [1]
The nonstructural protein 1 (NS1) antigenemia was significantly higher in dengue fatal cases when compared to Overall, the NS1 antigenemia was significantly higher in dengue fatal cases when compared non-dengue fatal ones (p = 0.01), Figure 1A
No differences were observed in NS1 levels between non-fatal and fatal
Summary
The incidence of dengue has increased dramatically around the world in recent decades, and an estimated 50–100 million cases occur annually [1]. The disease has a broad clinical spectrum ranging from a self-limiting disease in most individuals to a potentially fatal one [2,3]. In recent decades, dengue and severe dengue have become more frequent among adults [5]. In Brazil, dengue has become a major public health problem since the 1980s, and it has accounted for 60–80% of the cases reported in the Americas [6,7,8,9]. The co-circulation of four serotypes and the extensive epidemics occurring in Brazilian territory have led to an increased risk of severe and fatal cases [10,11,12,13]
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