Are viral loads in the febrile phase a predictive factor of dengue disease severity?

IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES BMC Infectious Diseases Pub Date : 2024-11-05 DOI:10.1186/s12879-024-10152-2
Shashika Dayarathna, Heshan Kuruppu, Tehani Silva, Laksiri Gomes, N L Ajantha Shyamali, Chandima Jeewandara, Dinuka Ariyaratne, Shyrar Tanussiya Ramu, Ananda Wijewickrama, Graham S Ogg, Gathsaurie Neelika Malavige
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Abstract

Background: As many studies have shown conflicting results regarding the extent of viraemia and clinical disease severity, we sought to investigate if viraemia during early dengue illness is associated with subsequent clinical disease severity.

Methods: Realtime PCR was carried out to identify the dengue virus (DENV serotype), in 362 patients, presenting within the first 4 days of illness, from 2017 to 2022, in Colombo Sri Lanka. To characterize subsequent clinical disease severity, all patients were followed throughout their illness daily and disease severity classified according to WHO 1997 and 2009 disease classification.

Results: 263 patients had DF, 99 progressed to develop DHF, and 15/99 with DHF developed shock (DSS). Although the viral loads were higher in the febrile phase in patients who progressed to develop DHF than in patients with DF this was not significant (p = 0.5). Significant differences were observed in viral loads in patients infected with different DENV serotypes (p = 0.0009), with lowest viral loads detected in DENV2 and the highest viral loads in DENV3. Sub-analysis for association of viraemia with disease severity for each DENV serotype was again not significant. Although those infected with DENV2 had lower viral loads, infection with DENV2 was significantly associated with a higher risk of developing DHF (p = 0.011, Odds ratio 1.9; 95% CI 1.164 to 3.078). Based on the WHO 2009 disease classification, 233 had dengue with warning signs (DWW), 114 dengue without warning signs (DWoWS), and 15 had severe dengue (SD). No significant difference was observed in the viral loads between those with SD, DWW and DWoWS (p = 0.27).

Conclusions: Viral loads were significantly different in the febrile phase between different DENV serotypes, and do not appear to significantly associate with subsequent clinical disease severity in a large Sri Lankan cohort.

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发热期的病毒载量是登革热病情严重程度的预测因素吗?
背景:关于登革热病毒血症和临床疾病严重程度的许多研究结果相互矛盾:由于许多研究在病毒血症程度和临床疾病严重程度方面显示出相互矛盾的结果,我们试图调查登革热早期发病期间的病毒血症是否与随后的临床疾病严重程度有关:方法:2017 年至 2022 年,我们对斯里兰卡科伦坡 362 名发病 4 天内的患者进行了实时 PCR 检测,以确定登革热病毒(DENV 血清型)。为了描述随后的临床疾病严重程度,对所有患者进行了每日全程随访,并根据世界卫生组织1997年和2009年疾病分类对疾病严重程度进行了分类。结果:263名患者患有登革热,99名进展为登革热性休克,15/99名登革热性休克患者出现休克(DSS)。虽然进展为 DHF 的患者发热期的病毒载量高于 DF 患者,但差异并不显著(p = 0.5)。在感染不同DENV血清型的患者中,病毒载量存在显著差异(p = 0.0009),DENV2的病毒载量最低,而DENV3的病毒载量最高。对每种 DENV 血清型的病毒血症与疾病严重程度的相关性进行的子分析结果也不显著。虽然DENV2感染者的病毒载量较低,但DENV2感染者罹患DHF的风险明显较高(p = 0.011,Odds ratio 1.9; 95% CI 1.164 to 3.078)。根据世界卫生组织 2009 年的疾病分类,233 例登革热患者有警示症状(DWW),114 例登革热患者无警示症状(DWoWS),15 例登革热患者病情严重(SD)。SD、DWW 和 DWoWS 患者的病毒载量无明显差异(p = 0.27):结论:在一个大型斯里兰卡队列中,不同血清型的登革热病毒在发热期的病毒载量有明显差异,但似乎与随后的临床疾病严重程度没有明显关联。
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来源期刊
BMC Infectious Diseases
BMC Infectious Diseases 医学-传染病学
CiteScore
6.50
自引率
0.00%
发文量
860
审稿时长
3.3 months
期刊介绍: BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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