Non-dengue Patients Research Articles

Evaluation of an Immunoglobulin E Capture Enzyme-Linked Immunosorbent Assay for the Early Diagnosis of Dengue.

Dengue virus (DENV) is the etiological agent of dengue, the most important mosquito-transmitted viral disease of humans worldwide. Enzyme-linked immunosorbent assays (ELISAs) designed to detect DENV IgM are commonly used for dengue diagnosis. However, DENV IgM is not reliably detected until ≥4 days after illness onset. Reverse transcription-polymerase chain reaction (RT-PCR) can diagnose early dengue but requires specialized equipment, reagents, and trained personnel. Additional diagnostic tools are needed. Limited work has been performed to determine whether IgE-based assays can be used for the early detection of vector-borne viral diseases, including dengue. In this study, we determined the efficacy of a DENV IgE capture ELISA for the detection of early dengue. Sera were collected within the first 4 days of illness onset from 117 patients with laboratory-confirmed dengue, as determined by DENV-specific RT-PCR. The serotypes responsible for the infections were DENV-1 and DENV-2 (57 and 60 patients, respectively). Sera were also collected from 113 dengue-negative individuals with febrile illness of undetermined etiology and 30 healthy controls. The capture ELISA detected DENV IgE in 97 (82.9%) confirmed dengue patients and none of the healthy controls. There was a high false positivity rate (22.1%) among the febrile non-dengue patients. In conclusion, we provide evidence that IgE capture assays have the potential to be explored for early diagnosis of dengue, but further research is necessary to address the possible false positivity rate among patients with other febrile illnesses.

1181. Predictive Score for Dengue Infection with Complete Blood Count Parameters, Including the New Monocyte Distribution Width – a Retrospective Single Center Derivation and Validation Study

Abstract Background Dengue infection is a differential diagnosis in patients with acute undifferentiated fever. Early detection and management may reduce mortality. Monocyte distribution width (MDW) is a new parameter in complete blood count (CBC). It is recently approved for early detection of sepsis. We have noticed high MDW in Dengue patients. This study aimed to describe MDW changes in Dengue infection and to develop predictive score for early detection of Dengue infected patients. Methods We retrospectively retrieved data of adult patients with acute fever who had CBC and Dengue serology (NS1 antigen, IgM and IgG) performed during September 2019 to May 2020 at Thammasat University Hospital. Medical records were reviewed. MDW was compared between groups. Patients were randomly divided into training and validation set. Predictive score was developed from the training set and validated in the validation set with multivariable analysis. Results A total of 431 patients, with Dengue infection in 127 patients (29.5%), were included in the analyses. The median (interquartile range) of MDW in Dengue patients were higher than non-Dengue patients [29.7% (26.5 – 34.7) vs. 24.2% (21.1 – 27.8), P < 0.001]. In patients with confirmed Dengue infection, MDW increased with increasing severity (Figure). Training and validation sets included 216 and 215 patients with 64 and 63 Dengue infection, respectively. Independent predictive factors of Dengue infection were white blood cell < 4 x 109 /L (score 1), platelet < 100 x 109 /L (score 1) and MDW > 24% (score 1). No clinical features were independently predictive of Dengue infection. The area under receiver-operating-characteristic curve (95% confidence interval) of the prognostic score in the training and validation set were 0.839 (0.779 – 0.899) and 0.742 (0.674 – 0.811), respectively. With the cut-off score ≥ 1, the sensitivity and specificity of the score were 92.2% and 40.8% in the training set and 88.9% and 44.1% in the validation set. Monocyte distribution width in Dengue and non-Dengue patients Box-plot showing monocyte distribution width in patients with Dengue in comparison with non-Dengue (panel A) and compared between each Dengue severity (panel B) Conclusion MDW increase in patients with Dengue infection and also increase with Dengue severity. We have developed and internally validated a simple predictive score for Dengue infection based on only results from CBC and MDW. Further large-scale external validation study is required to confirm the utility of our predictive score. Disclosures All Authors: No reported disclosures.

A case-control study to determine the risk factors of dengue fever in Chattogram, Bangladesh

ObjectivesIn a tropical country like Bangladesh, where the climatic condition favors the growth of Aedes mosquito vectors, the success of dengue prevention depends largely on the proper identification and control of risk factors. Therefore this study was aimed to explore the potential risk factors and their association with dengue infection. Study designA case-control study including 150 cases and 150 controls was conducted in Chattogram district of Bangladesh. Cases were confirmed dengue patients admitted in Chattogram medical college hospital and Bangladesh institute of tropical and infectious diseases during August and September 2019. On the other hand, controls were non-dengue patients admitted in other departments of the same hospitals through gender, age, and location matching. MethodsThe questionnaire data were collected through telephone-based interviews, which included general demography, daily life activities, housing and surrounding environment of participants. Chi-square and binary logistic regression were performed to identify potential risk factors. ResultsThe study found that travel history to the high incidence area, staying most of the daytime in office (AOR = 18.10), living in 21–40 years old houses (AOR = 9.74), and the temporary residency in the city (AOR = 10.20) were statistically significant risk factors for getting dengue infection. However, day time sleep, house type and structure, number of family members, morning and evening walk, plant in resident, and junk yard around 250 m of the house were also showed a significant effect in chi square test. ConclusionsResults strengthen our understanding regarding the role of factors associated with daily lifestyle and living environment of people in the development of dengue and hence support the dengue control program in Bangladesh. The study will provide a basis for future extended research covering different parts of the country.

725. Complete Blood Count Values Vary in Degree of Change with Day of Fever in Children with Dengue Fever

BackgroundDengue fever (DF) is an acute viral disease which can lead to severe illness, including dengue hemorrhagic fever, marked by thrombocytopenia and hemolytic anemia, as well as end-organ damage. Despite the well-known presentation and prevalence, changes in hematologic markers across the DF course have not been well-described in children. We sought to investigate the association of clinical laboratory values over time with dengue disease progression and outcome in a pediatric population in the Dominican Republic.MethodsPediatric participants were enrolled at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo, Dominican Republic, in a prospective, observational case-based study. Laboratory values, including complete blood count (CBC) indices and dengue titer results, were collected over the course of hospital stay. Using linear mixed models, we assessed whether 13 different CBC values and time trajectories differed by dengue status, including age and sex as covariates. To account for multiple testing, p≤0.0033 was considered significant.ResultsA total of 575 children ages 0 to 211 months met inclusion criteria; 51.8% (n=298) were male, and the median (IQR) age was 59 (14-93) months. Eighty-two percent (n=472) of participants had DF. CBC values across days 1 to 10 of fever in those with and without DF are depicted in Figure 1. Those with DF showed levels dropping more quickly across days of fever for hematocrit and hemoglobin (p≤ 0.002), with a more rapid decline in those with severe DF (p < 0.0001). Those with DF had levels increasing more quickly for mean corpuscular hemoglobin concentration (MCHC), monocyte number, and white blood cell counts (p ≤ 0.003), with those with severe DF having a more rapid increase (p < 0.001). The direction of the change across time differed by DF status for mean corpuscular volume and red blood cell distribution width (RDW) (p ≤ 0.0003), with those with severe DF showing an increase in RDW across day of fever (p= 0.0004).Figure 1. CBC values across day of fever in dengue (blue) and non-dengue (purple) patients. The graph above depicts the following CBC values across day of fever in dengue (blue) and non-dengue (purple) patients: a) white blood cell (WBC) count, b) platelet count, c) monocyte number, d) hemoglobin, e) mean corpuscular hemoglobin concentration (MCHC), and f) mean corpuscular volume (MCV). Values with an asterisk (*) represent significant values (p < 0.0033).ConclusionThe trajectory of CBC measures differs between those with and without DF, despite similar clinical presentations. These laboratory differences may facilitate a better understanding of the clinical course of DF and may aid in earlier identification of DF in resource-limited settings. Disclosures Elizabeth P. Schlaudecker, MD, MPH, Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member)

Direct costs of managing in-ward dengue patients in Sri Lanka: A prospective study.

IntroductionThe cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential.ObjectiveTo characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka.MethodsColombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios.ResultsFrom October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients.ConclusionAs non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.

Environmental factors influencing Prevention and Control of Schistosomiasis Infection in Mwea, Kirinyaga County Kenya: A cross sectional study.

Background:Dengue is a viral disease transmitted by female Aedes mosquitoes which are commonly found in tropical and subtropical areas. There is a dramatic increase in annual incidence rate of dengue attributed to urbanisation, poor environmental management as well as increased people mobility. Outbreak of dengue have been reported in Tanzania in recent years with Dar es salaam being the most affected region. Dengue is associated with haematological derangements and itindicates the severity of the disease. These changes have not been well elucidated in Tanzanian patients. The aim of this study was to determine these derangements among dengue patients admitted at Kairuki hospital in Dar es salaam, and compare these changes with non-dengue febrile patients.Methods:A retrospective cross sectional study was conducted among patients who were suspected to have dengue; tested for dengue IgM and their Complete Blood Count were tested during the index illness. This information was obtained from Kairuki hospital laboratory database. Haematological parameters were compared between dengue and non-dengue patients using SPSS Version 20.0. Binary logistic regression analysis was used to determine haematological predictors of dengue positive results.Results:A total of 255 patients were enrolled, whereby 188(73.7%) were dengue positive and 67 (26.3%) were negative. Dengue patients had relatively low mean total white blood cell counts compared to non-dengue patients (Students test= −2.7; p value=.007). Furthermore, Mean lymphocyte count was significantly low in dengue patients compared to non-dengue patients (Student's (t) test=−5.1; p<.001). Other haematological parameters were not significantly different. Lymphopenia was a significant predictor for dengue positive results (Adjusted Odd Ration =5.26 (95% CI=2.28–12.2; P value <.001).Conclusion:Patients with dengue had significantly low total white blood cell and lymphocyte count compared to non-dengue febrile patients. Lymphopenia is a significant haematological predictor for dengue positive results. Case defining signs and symptoms combined with these haematological changes may be used by clinicians as a guide to order confirmatory test for suspected dengue cases.

Dengue and post-infection fatigue: findings from a prospective cohort-the Colombo Dengue Study.

Previous studies on post-infection fatigue in dengue are few but suggest that up to 25% of dengue patients may suffer from fatigue. This study aimed to evaluate the prevalence and associations of post-infection fatigue in dengue patients compared with non-dengue fever patients. Post-infection fatigue and its demographic and clinical associations were assessed in adult dengue and non-dengue fever patients 2months after the acute infection in a prospective cohort study in Sri Lanka. Fatigue at 2months (primary endpoint) was assessed with the fatigue questionnaire as a dichotomous outcome based on a pre-recommended cut-off (score ≥4) and as the total score from the questionnaire (higher score indicates more fatigue). Of 260 patients, 158 had dengue and, of these, 51 (32%) had fatigue at 2months. Risk was higher in dengue patients (vs non-dengue; relative risk [RR] 4.93 [95% confidence interval {CI} 2.3 to 10.4]) and more so in female dengue patients (vs male dengue patients; RR 2.45 [95% CI 1.24 to 4.86]). Severe dengue patients had a higher mean fatigue score (p=0.024). Post-infection fatigue is an underappreciated burden of this widely prevalent infection. Our findings are useful to triage patients at risk of fatigue for follow-up.

Development and Performance of Dengue Diagnostic Clinical Algorithms in Colombia.

Diagnosing dengue in endemic areas remains problematic because of the low specificity of the symptoms and lack of accurate diagnostic tests. This study aimed to develop and prospectively validate, under routine care, dengue diagnostic clinical algorithms. The study was carried out in two phases. First, diagnostic algorithms were developed using a database of 1,130 dengue and 918 non-dengue patients, expert opinion, and literature review. Algorithms with > 70% sensitivity were prospectively validated in a single-group quasi-experimental trial with an adaptive Bayesian design. In the first phase, the algorithms that were developed with the continuous Bayes formula and included leukocytes and platelet counts, in addition to selected signs and symptoms, showed the highest sensitivities (> 80%). In the second phase, the algorithms were applied on admission to 1,039 consecutive febrile subjects in three endemic areas in Colombia of whom 25 were laboratory-confirmed dengue, 307 non-dengue, 514 probable dengue, and 193 undetermined. Including parameters of the hemogram consistently improved specificity without affecting sensitivity. In the final analysis, considering only confirmed dengue and non-dengue cases, an algorithm with a sensitivity and specificity of 65.4% (95% credibility interval 50-83) and 40.1% (34.7-45.7) was identified. All tested algorithms had likelihood ratios close to 1, and hence, they are not useful to confirm or rule out dengue in endemic areas. The findings support the use of hemograms to aid dengue diagnosis and highlight the challenges of clinical diagnosis of dengue.

Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results

BackgroundReports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia.MethodsAcute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management.ResultsR. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities.ConclusionsRickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.

Comparison of Two Commercial ELISA Kits for the Detection of Anti-Dengue IgM for Routine Dengue Diagnosis in Laos.

The endemicity of Dengue virus (DENV) infection remains a major public health problem in Lao PDR. In this study, we compared two commercial anti-dengue IgM ELISA kits, Panbio® Dengue IgM Capture ELISA (Panbio Kit, Alere, Waltham, MA, USA) and DEN DetectTM MAC-ELISA (InBios kit, InBios International, Inc., Seattle, WA, USA), in the context of diagnosis of patients admitted to hospital with clinical dengue presentation. Two panels of paired blood samples were tested. Panel A was composed of 54 dengue confirmed patients (by DENV real-time RT-PCR) and 11 non-dengue dengue patients (other infections confirmed by corresponding PCR results). Panel B included 74 patients randomly selected from consecutive patients admitted to Mahosot Hospital in 2008 with suspicion of dengue fever according to WHO criteria. Results from panel A showed significantly better sensitivity for Panbio kit (64.8%; 95%CI: 50.6–77.3%) than for InBios kit (18.5%; 95%CI: 9.3–31.4%) when testing admission sera. Sensitivity was increased for both kits when combining results from admission and convalescent sera. Concordant results were obtained from panel B with fair agreement (κ = 0.29) between both kits when testing single admission samples, and moderate agreement (κ = 0.5) when combining results from admission and convalescent sera.

Accuracy of the SD BIOLINE Dengue Duo for rapid point-of-care diagnosis of dengue.

BackgroundRapid diagnosis tests (RDTs) are easy to carry out, provide fast results, and could potentially guide medical treatment decisions. We investigated the performance of a commercially available RDT, which simultaneously detects the non-structural 1 (NS1) dengue virus (DENV) antigen, and IgM and IgG DENV antibodies, using representative serum samples from individuals in a dengue endemic area in Salvador, Brazil.Methodology/Principal findingsWe evaluated the accuracy of the SD BIOLINE Dengue Duo RDT (Abbott, Santa Clara, USA; former Alere Inc, Waltham, USA) in a random collection of sera. Samples included acute-phase sera from 246 laboratory-confirmed dengue cases and 108 non-dengue febrile patients enrolled in a surveillance study for dengue detection, 73 healthy controls living in the same surveillance community, and 73 blood donors. RDT accuracy was blindly assessed based on the combined results for the NS1 and the IgM test components. The RDT sensitivity was 46.8% (38.6% for the NS1 component and 13.8% for the IgM component). Sensitivity was greater for samples obtained from patients with secondary DENV infections (49.8%) compared to primary infections (31.1%) (P: 0.02) and was also influenced by the result in the confirmatory dengue diagnostic test, ranging from 39.7% for samples of cases confirmed by IgM-ELISA seroconversion between paired samples to 90.4% for samples of cases confirmed by a positive NS1-ELISA. The RDT specificity was 94.4% for non-dengue febrile patients, 87.7% for the community healthy controls, and 95.9% for the blood donors.Conclusions/SignificanceThe SD BIOLINE Dengue Duo RDT showed good specificities, but low sensitivity, suggesting that it may be more useful to rule in than to rule out a dengue diagnosis in dengue endemic regions.

Accuracy and reliability of an NS1 rapid immunochromatographic test for DENV-1 diagnosis at point of care and in the laboratory

BackgroundRapid immunochromatographic tests (ICT) for dengue non-structural protein 1 (NS1) have shown good performance for diagnosing acute-phase dengue in serum in laboratory settings, but rarely have been assessed in whole blood and at point of care (POC). This study compare the accuracy and inter- and intra-observer reliability of the NS1 Bioeasy™ ICT in whole blood at POC versus serum in the laboratory, during a DENV-1 epidemic.MethodsCross-sectional study involving 144 adults spontaneously demanding care in an emergency department within 4 days of onset of acute febrile illness. Accuracy of NS1 Bioeasy™ ICT was compared in whole blood and serum, both at 15 and 30 min, blinded to the reference RT-PCR or NS1 ELISA. Non-dengue patients were also tested for Zika virus with RT-PCR. Reliability of whole blood and serum readings by the same or different observers was measured by simple kappa (95% CI).ResultsAt 15 min, sensitivity (Sn) of NS1 Bioeasy™ ICT in whole blood/POC was 76.7% (95% CI: 68.0–84.1) and specificity (Sp) was 87.0% (95% CI: 66.4–97.2). Sn in serum/laboratory was 82% (95% CI: 74.1–88.6) and Sp 100% (95% CI: 85.8–100). Positive likelihood ratio was 5.9 (95% CI: 2.0–17.0) for whole blood/POC and 19.8 (95% CI: 2.9–135.1) for serum/laboratory. Reliability of matched readings of whole blood/POC and serum/laboratory by the same observer (k = 0.83, 95% CI: 0.74–0.93) or different observers (k = 0.81, 95% CI: 0.72–0.92) was almost perfect, with higher discordant levels in the absence of dengue. Results did not differ statistically at 5%.ConclusionsNS1 Bioeasy™ ICT in DENV-1 epidemics is a potentially confirmatory test. Invalid results at 15 min should be reread at 30 min. To optimize impact of implementing ICT in the management of false-negatives it should be incorporated into an algorithm according to setting and available specimen.Trial registrationUTN U1111-1145-9451.

Serum Galectin-9 and Galectin-3-Binding Protein in Acute Dengue Virus Infection.

Dengue fever is a serious threat for public health and induces various inflammatory cytokines and mediators, including galectins and glycoproteins. Diverse immune responses and immunological pathways are induced in different phases of dengue fever progression. However, the status of serum galectins and glycoproteins is not fully determined. The aim of this study was to investigate the serum concentration and potential interaction of soluble galectin-1, galectin-3, galectin-9, galectin-3 binding protein (galectin-3BP), glycoprotein 130 (gp130), and E-, L-, and P-selectin in patients with dengue fever in acute febrile phase. In this study, 317 febrile patients (187 dengue patients, 150 non-dengue patients that included 48 patients with bacterial infection and 102 patients with other febrile illness) who presented to the emergency department and 20 healthy controls were enrolled. Our results showed the levels of galectin-9 and galectin-3BP were significantly higher in dengue patients than those in healthy controls. Lower serum levels of galectin-1, galectin-3, and E-, L-, and P-selectin in dengue patients were detected compared to bacteria-infected patients, but not to healthy controls. In addition, strong correlation between galectin-9 and galectin-3BP was observed in dengue patients. In summary, our study suggested galectin-9 and galectin-3BP might be critical inflammatory mediators in acute dengue virus infection.

Study of viremic profile in febrile specimens of chikungunya in Bandung, Indonesia

BackgroundData regarding the viremia profile of chikungunya virus (CHIKV) infected patients especially during the pre-febrile period is limited. ObjectiveTo obtain virological kinetic data on CHIKV infections. Study designA two-week community observation for dengue transmission was conducted in Bandung, Indonesia, from 2005 to 2009. Acute specimens from non-dengue febrile patients were screened by pan-alphavirus conventional RT-PCR. The positives were confirmed for CHIKV RNA by a specific RT-PCR followed by sequencing. Simultaneously these specimens were also cultured in Vero cells and tested for anti-CHIK IgM MAC-ELISA. All the available serial specimens,including the pre-febrile specimens, from confirmed CHIK cases, were tested by virus isolation, RT-PCR, qRT-PCR, and CHIK IgM ELISA. ResultsThere were five laboratory confirmed CHIK cases identified and studied. Among these, viremia was determined to extend from as early as 6 days prior to until 13 days post fever onset. Quantitative RT-PCR showed viremia peaked at or near onset of illness. ConclusionIn this study, individuals were identified with viremia prior to fever onset and extending beyond the febrile phase. This extended viremic phase has the potential to impact transmission dynamics and thus the public health response to CHIK outbreaks.

Correlation of Clinicohaematological Parameters in Paediatric Dengue: A Retrospective Study.

Dengue is one of the arthropod-borne (arbo) viral diseases transmitted by female mosquito Aedes aegypti. Dengue fever has a wide spectrum of clinical presentation ranging from flu-like illness to severe complicated stage of dengue hemorrhagic fever leading to mortality. This was a retrospective study conducted in a tertiary care hospital in Coastal Karnataka, South India, to know the correlation between the clinical presentation and haematological parameters in the paediatric cases presented with dengue symptoms. A total of 163 paediatric cases who presented fever and dengue-like illness were included in the study. Of which, 69 were confirmed dengue patients. Critical analysis showed that there was a significant difference in the haematological parameters like total leucocyte count, percent differential leucocyte count, and platelets count, in the erythrocyte sedimentation rate (P < 0.05 to 0.0001). Additionally, when compared to nondengue patients, even the liver function and renal function parameters were significantly deranged (P < 0.05 to 0.0001). Stratification based on NS1, IgG, and IgM showed significant alterations in the haematological, hepatic, and renal parameters. With respect to the treatment a small percentage of patients, that is, 8% (4 patients), required platelet transfusion as their counts went below 20,000/μL. Two patients succumbed to their illness while three required ICU stay.

Comparison of the clinical manifestations exhibited by dengue and nondengue patients among children in a medical center in southern Taiwan

Dengue is one of the most important mosquito-borne diseases. Taiwan is located in an epidemic area for dengue, and several dengue outbreaks have been reported in southern Taiwan. Therefore, we conducted this study to determine the incidence and clinical manifestations of symptomatic dengue infection. We reviewed the medical records of 177 pediatric patients (age < 16 years) who underwent serum tests for dengue (polymerase chain reaction or capture enzyme-linked immunosorbent assay for dengue immunoglobulin M and immunoglobulin G antibodies) in the pediatric outpatient clinic, the pediatric ward, or the emergency department of the Chi-Mei Medical Center from January 1, 2007 to December 31, 2007. We evaluated the differences in the clinical characteristics and laboratory data between the dengue and nondengue patients. Most of the dengue cases appeared starting in July and peaked during November. In the dengue group, there were more school-age patients (age > 7 years) and a more frequent history of mosquito contact. There was no difference in the sex distribution. Most of the dengue patients had obvious symptoms including skin rash (79.0%), nausea/vomiting (47.4%), high fever (> 39°C; 44.7%), diarrhea (26.3%), abdominal pain (23.7%), and petechiae (15.8%). Leukopenia, thrombocytopenia, elevated aspartate aminotransferase levels, and elevated alanine aminotransferase levels were found in 78.4%, 79.3%, 34.5%, and 29.0% of the patients, respectively. Nondengue patients showed elevated C-reactive protein levels (57.5%). Dengue is commonly found in older pediatric patients and is rare in infants. High fever and skin and gastrointestinal manifestations were usually found in dengue patients. The laboratory findings of leukopenia, thrombocytopenia, elevated levels of liver enzymes, and low C-reactive protein levels were common in dengue patients, and these markers could help confirm the suspicion of pediatric dengue infection.

Elevated levels of total and dengue virus-specific immunoglobulin E in patients with varying disease severity.

The kinetics of total and dengue virus-specific immunoglobulin E (IgE) were studied in serial serum samples obtained from 168 patients, 41 of whom suffered from primary dengue virus infection and 127 suffered from secondary dengue virus infection. Seventy-one patients were classified as dengue fever, 30 as dengue hemorrhagic fever, and 67 as dengue shock syndrome. A control group included single serum samples from patients with a herpes virus infection (n = 14), non-dengue febrile patients (n = 10), and healthy blood donors (n = 10). Patients with dengue virus infection had higher levels of total and dengue virus-specific IgE than non-dengue patients (P < 0.05). Patients with secondary dengue virus infections had not significantly increased levels of both total and dengue virus-specific IgE in the acute phase of disease compared to patients with primary dengue virus infections. Dengue virus-specific IgE was significantly higher in dengue hemorrhagic fever and/or dengue shock syndrome patients compared to dengue fever and non-dengue patients (P < 0.05). In conclusion, this study showed elevated total and dengue virus-specific IgE serum antibody levels in the acute stage of disease. Therefore, measurement of both total and dengue virus-specific IgE serum antibodies can be used as an additional prognostic marker in the development of severe complications in dengue virus infections. In addition, the presence and increase of dengue virus-specific IgE serum antibodies in patients with dengue virus infections is suggestive of the pathogenetic role that IgE may play in the hemostatic disorders observed in dengue hemorrhagic fever and dengue shock syndrome.