Abstract
Hantavirus and dengue virus (DENV) infections are caused by RNA viruses which infect immune systems’ cells including monocytes, macrophages and dendritic cells and occur year-round in Barbados. A retrospective serological study (2008–2015) was conducted on hantavirus and dengue patient sera confirmed by IgM and IgG ELISA, NS1 and RT-PCR using Limulus amoebocyte lysate (LAL) kinetic turbidimetric method to determine serum endotoxin levels. Hantavirus patients were categorized into two groups, namely (a) hospitalized and (b) non-hospitalized. Dengue patients were categorized into 3 groups using 2009 WHO dengue guidelines (a) severe dengue (SD), (b) hospitalized non-severe dengue (non-SD) and (c) non-hospitalized non-SD. Statistical analyses were conducted to determine the association of endotoxin levels with hantavirus disease severity based on hospitalization and dengue disease severity. Serum endotoxin levels are associated with hantavirus disease severity and hospitalization and dengue disease severity (p < 0.01). Similar studies have found an association of serum endotoxin levels with dengue disease severity but never with hantavirus infection. Co-detection of hantavirus- and DENV-specific IgM in some patients were observed with elevated serum endotoxin levels. In addition, previous studies observed hantavirus replication in the gut of patients, gastrointestinal tract as a possible entry route of infection and evidence of microbial translocation and its impact on hantavirus disease severity. A significant correlation of serum endotoxin and hantavirus disease severity and hospitalization in hantavirus infected patients is reported for the first time ever. In addition, serum endotoxin levels correlated with dengue disease severity. This study adds further support to the role of endotoxin in both hantavirus and dengue virus infection and disease severity and its role as a possible therapeutic target for viral haemorrhagic fevers (VHFs).
Highlights
IntroductionDengue viruses (DENVs) and hantaviruses are global health threats accounting for 58.4 million annual dengue cases and as many as 0.2 million annual hantavirus infections respectively [1,2]
Dengue viruses (DENVs) and hantaviruses are global health threats accounting for 58.4 million annual dengue cases and as many as 0.2 million annual hantavirus infections respectively [1,2].With both dengue and hantavirus infection, the role of the vector is important namely the mosquito primarily Aedes aegypti and rodents (Muridinae family e.g., rats and mice) respectively
We aimed to investigate the role of serum endotoxin levels (a) in hantavirus disease severity, (b) in dengue disease severity in the Caribbean using 2009 WHO dengue guidelines and (c) and their correlation with clinical parameters among severe dengue (SD) and hospitalised non-severe dengue patients
Summary
Dengue viruses (DENVs) and hantaviruses are global health threats accounting for 58.4 million annual dengue cases and as many as 0.2 million annual hantavirus infections respectively [1,2]. With both dengue and hantavirus infection, the role of the vector is important namely the mosquito primarily Aedes aegypti and rodents (Muridinae family e.g., rats and mice) respectively. DENV and hantaviruses are both RNA viruses, which infect similar human host cells. DENV infection can lead to dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). DENV and hantavirus infections have similar clinical symptoms making the differential diagnosis difficult without the use of clinical laboratory diagnostic testing
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