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Aggarwal C, Ahmed H, Sharma P, Reddy ES, Nayak K, Singla M, Maheshwari D, Chawla YM, Panda H, Rai RC, Gunisetty S, Priyamvada L, Bhaumik SK, Ahamed SF, Vivek R, Bhatnagar P, Singh P, Kaur M, Dixit K, Kumar S, Gottimukkala K, Saini K, Bajpai P, Sreekanth GP, Mammen S, Rajan A, Verghese VP, Abraham AM, Shah P, Alagarasu K, Yu T, Davis CW, Wrammert J, Ansari A, Antia R, Kabra SK, Medigeshi GR, Ahmed R, Lodha R, Shet A, Chandele A, Murali-Krishna K. Severe disease during both primary and secondary dengue virus infections in pediatric populations. Nat Med 2024; 30:670-674. [PMID: 38321219 DOI: 10.1038/s41591-024-02798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Dengue is a global epidemic causing over 100 million cases annually. The clinical symptoms range from mild fever to severe hemorrhage and shock, including some fatalities. The current paradigm is that these severe dengue cases occur mostly during secondary infections due to antibody-dependent enhancement after infection with a different dengue virus serotype. India has the highest dengue burden worldwide, but little is known about disease severity and its association with primary and secondary dengue infections. To address this issue, we examined 619 children with febrile dengue-confirmed infection from three hospitals in different regions of India. We classified primary and secondary infections based on IgM:IgG ratios using a dengue-specific enzyme-linked immunosorbent assay according to the World Health Organization guidelines. We found that primary dengue infections accounted for more than half of total clinical cases (344 of 619), severe dengue cases (112 of 202) and fatalities (5 of 7). Consistent with the classification based on binding antibody data, dengue neutralizing antibody titers were also significantly lower in primary infections compared to secondary infections (P ≤ 0.0001). Our findings question the currently widely held belief that severe dengue is associated predominantly with secondary infections and emphasizes the importance of developing vaccines or treatments to protect dengue-naive populations.
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Affiliation(s)
- Charu Aggarwal
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Hasan Ahmed
- Department of Biology, Emory University, Atlanta, GA, USA
| | - Pragati Sharma
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Elluri Seetharami Reddy
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- Kusuma School of Biological Sciences, Indian Institute of Technology, New Delhi, India
| | - Kaustuv Nayak
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Mohit Singla
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Maheshwari
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Yadya M Chawla
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Harekrushna Panda
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ramesh Chandra Rai
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Sivaram Gunisetty
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Lalita Priyamvada
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Siddhartha Kumar Bhaumik
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Syed Fazil Ahamed
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Rosario Vivek
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
- The University of Trans-Disciplinary Health Sciences & Technology, Bengaluru, India
| | - Priya Bhatnagar
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- TERI school of advanced studies, New Delhi, India
| | - Prabhat Singh
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Manpreet Kaur
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kritika Dixit
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Sanjeev Kumar
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kamal Gottimukkala
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Keshav Saini
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Prashant Bajpai
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Gopinathan Pillai Sreekanth
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Shobha Mammen
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Anand Rajan
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Valsan Philip Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Asha Mary Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Paresh Shah
- Department of Molecular Virology, National Institute of Virology, Pune, India
| | - Kalichamy Alagarasu
- Department of Molecular Virology, National Institute of Virology, Pune, India
| | - Tianwei Yu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Shenzhen Research Institute of Big Data, School of Data Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Carl W Davis
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Jens Wrammert
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Aftab Ansari
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Rustom Antia
- Department of Biology, Emory University, Atlanta, GA, USA
| | - Sushil Kumar Kabra
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Guruprasad R Medigeshi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Rakesh Lodha
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Anita Shet
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India.
- International Vaccine Access Centre, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Anmol Chandele
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India.
| | - Kaja Murali-Krishna
- ICGEB Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India.
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA.
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Kanagavalli P, Andrew C, Anand Babu K, Jayakumar M, Veerapandian M. Label-free genosensing of dengue serotypes with an electrodeposited reduced graphene oxide-tris(bipyridine)ruthenium(II). Int J Biol Macromol 2023; 253:126746. [PMID: 37689295 DOI: 10.1016/j.ijbiomac.2023.126746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
Constructing a label-free electrochemical transducer platform without compromising inherent biocompatibility against specific bioreceptor remains challenging, particularly probing nucleic acid hybridization at electrode interface without external redox-mediator. Here, we show that electrochemically reduced graphene oxide-tris(bipyridine)ruthenium(II) (ErGO-TBR) nanosheets electrodeposited on carbon screen printed electrode can quantify hybridization of clinically important target sequences specific to serotypes of dengue virus (DENV) non-structural 1 (NS1) protein. Different variables including deposition potential, time, and electrolytic composition were optimized for fabrication of label-free transducer platform. Structural and electrochemical properties of ErGO-TBR/SPE were comprehensively elucidated using microscopic and spectroscopic techniques. Electrochemical quartz crystal microbalance (EQCM) analysis reveals the growth of electrodeposited redox-active species on the electrode interface. Surface functional group investigations suggested that TBR deposited on the basal and edges of ErGO substrate via electrostatic and π-π interactions. Functionalization of bio-affinity layer (B) on ErGO-TBR/SPE enables better loading of probe DNA (PDNA) toward specific detection of DENV target DNA (TDNA) with an ultralow detection limit promising for clinical diagnosis. Scalable chronoamperometry-based redox-active surface growth, customizable bioactivation strategy and external mediator-less probing of nucleic acid hybridization make the present system suitable for other translational application in healthcare diagnosis.
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Affiliation(s)
- Pandiyaraj Kanagavalli
- Electrodics & Electrocatalysis Division, CSIR-Central Electrochemical Research Institute (CECRI), Karaikudi, Tamil Nadu 630 003, India; Academy of Scientific & Innovative Research (AcSIR), Ghaziabad 201 002, India
| | - Chrysanthus Andrew
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad 201 002, India; Electroplating and Metal Finishing Division, CSIR-CECRI, Karaikudi, Tamil Nadu 630 003, India; Department of Chemical Sciences, Federal University, Wukari 1020, Nigeria
| | - Kannadasan Anand Babu
- Anderson Clinical Genetics, Anderson Diagnostic Services Private Limited, Chennai 600 010, Tamil Nadu, India
| | - Mani Jayakumar
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad 201 002, India; Electroplating and Metal Finishing Division, CSIR-CECRI, Karaikudi, Tamil Nadu 630 003, India.
| | - Murugan Veerapandian
- Electrodics & Electrocatalysis Division, CSIR-Central Electrochemical Research Institute (CECRI), Karaikudi, Tamil Nadu 630 003, India; Academy of Scientific & Innovative Research (AcSIR), Ghaziabad 201 002, India.
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Tsai JJ, Tsai CY, Lin PC, Chen CH, Tsai WY, Dai YC, Lin YC, Pedroso C, Brites C, Wang WK. Comparing the performance of dengue virus IgG and IgG-capture enzyme-linked immunosorbent assays in seroprevalence study. BMC Infect Dis 2023; 23:301. [PMID: 37158835 PMCID: PMC10165301 DOI: 10.1186/s12879-023-08307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Dengue virus (DENV) is the leading cause of arboviral diseases in humans worldwide. Currently Dengvaxia, the first dengue vaccine licensed in 20 countries, was recommended for DENV seropositive individuals aged 9-45 years. Studying dengue seroprevalence can improve our understanding of the epidemiology and transmission dynamics of DENV, and facilitate future intervention strategies and assessment of vaccine efficacy. Several DENV envelope protein-based serological tests including IgG and IgG-capture enzyme-linked immunosorbent assays (ELISAs) have been employed in seroprevalence studies. Previously DENV IgG-capture ELISA was reported to distinguish primary and secondary DENV infections during early convalescence, however, its performance over time and in seroprevalence study remains understudied. METHODS In this study, we used well-documented neutralization test- or reverse-transcription-polymerase-chain reaction-confirmed serum/plasma samples including DENV-naïve, primary and secondary DENV, primary West Nile virus, primary Zika virus, and Zika with previous DENV infection panels to compare the performance of three ELISAs. RESULTS The sensitivity of the InBios IgG ELISA was higher than that of InBios IgG-capture and SD IgG-capture ELISAs. The sensitivity of IgG-capture ELISAs was higher for secondary than primary DENV infection panel. Within the secondary DENV infection panel, the sensitivity of InBios IgG-capture ELISA decreased from 77.8% at < 6 months to 41.7% at 1-1.5 years, 28.6% at 2-15 years and 0% at > 20 years (p < 0.001, Cochran-Armitage test for trend), whereas that of IgG ELISA remains 100%. A similar trend was observed for SD IgG-capture ELISA. CONCLUSIONS Our findings demonstrate higher sensitivity of DENV IgG ELISA than IgG-capture ELISA in seroprevalence study and interpretation of DENV IgG-capture ELISA should take sampling time and primary or secondary DENV infection into consideration.
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Affiliation(s)
- Jih-Jin Tsai
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yi Tsai
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Chang Lin
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Hong Chen
- National Mosquito-Borne Diseases Control Research Center, Zhunan, Taiwan
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Yang Tsai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Yu-Ching Dai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Yen-Chia Lin
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Celia Pedroso
- LAPI-Laboratório de Pesquisa em Infectologia-School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- LAPI-Laboratório de Pesquisa em Infectologia-School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
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Chan KR, Ismail AA, Thergarajan G, Raju CS, Yam HC, Rishya M, Sekaran SD. Serological cross-reactivity among common flaviviruses. Front Cell Infect Microbiol 2022; 12:975398. [PMID: 36189346 PMCID: PMC9519894 DOI: 10.3389/fcimb.2022.975398] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
The Flavivirus genus is made up of viruses that are either mosquito-borne or tick-borne and other viruses transmitted by unknown vectors. Flaviviruses present a significant threat to global health and infect up to 400 million of people annually. As the climate continues to change throughout the world, these viruses have become prominent infections, with increasing number of infections being detected beyond tropical borders. These include dengue virus (DENV), West Nile virus (WNV), Japanese encephalitis virus (JEV), and Zika virus (ZIKV). Several highly conserved epitopes of flaviviruses had been identified and reported to interact with antibodies, which lead to cross-reactivity results. The major interest of this review paper is mainly focused on the serological cross-reactivity between DENV serotypes, ZIKV, WNV, and JEV. Direct and molecular techniques are required in the diagnosis of Flavivirus-associated human disease. In this review, the serological assays such as neutralization tests, enzyme-linked immunosorbent assay, hemagglutination-inhibition test, Western blot test, and immunofluorescence test will be discussed. Serological assays that have been developed are able to detect different immunoglobulin isotypes (IgM, IgG, and IgA); however, it is challenging when interpreting the serological results due to the broad antigenic cross-reactivity of antibodies to these viruses. However, the neutralization tests are still considered as the gold standard to differentiate these flaviviruses.
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Affiliation(s)
- Kai Rol Chan
- Faculty of Medical and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Amni Adilah Ismail
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gaythri Thergarajan
- Faculty of Medical and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Chandramathi Samudi Raju
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Shamala Devi Sekaran, ; Chandramathi Samudi Raju,
| | - Hock Chai Yam
- Faculty of Medical and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Manikam Rishya
- Department of Trauma and Emergency Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Shamala Devi Sekaran
- Faculty of Medical and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
- *Correspondence: Shamala Devi Sekaran, ; Chandramathi Samudi Raju,
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Lima MRQ, Nunes PCG, Dos Santos FB. Serological Diagnosis of Dengue. Methods Mol Biol 2022; 2409:173-196. [PMID: 34709642 DOI: 10.1007/978-1-0716-1879-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A reliable and specific diagnosis is imperative in viral diagnosis, both for clinical management and surveillance, and to ensure that early treatment and control measures are carried out. The number of days of illness is important to choose the most appropriate method to be used and for the correct interpretation of the results obtained. Specific IgM is elicited after that period, indicating an active infection and usually lasts up to 3 months. However, in DENV secondary infections, IgM levels may be significantly lower or undetectable. After 10-12 days, a lifetime specific IgG is produced. Routinely, the laboratory diagnosis of DENV infections can be performed by viral isolation and/or detection of viral nucleic acid, serological assays for the detection of specific antibodies (IgM/IgG), antigen (NS1) and the detection of viral antigens in tissues, which are suitable during certain phases of the disease. For serological diagnosis, serum, plasma, or cerebrospinal fluid (CSF) samples may be investigated. If the test is carried out a few days after collection, the specimens can be stored at 4 °C, since the immunoglobulins are stable in serum or plasma. If the storage period is extended, the material must be kept at -20 °C or -70 °C. In serology, several methods can be used to detect specific viral antigens and/or antibodies, produced by the host in response to DENV infection. Routinely, serological tests include the hemagglutination inhibition (HI) assay, the plaque reduction neutralizing test (PRNT), the gold standard assay for dengue immune response characterization, and ELISAs to detect IgM (MAC-ELISA) and IgG (IgG-ELISA).
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Affiliation(s)
- Monique R Q Lima
- Laboratório Estratégico de Diagnóstico (LED), Centro de Desenvolvimento Científico, Instituto Butantan, São Paulo, Brazil
| | - Priscila C G Nunes
- Laboratório Municipal de Saúde Pública (LASP), Laboratório de Virologia e Biotério, Subsecretaria de Vigilância, Fiscalização Sanitária e Controle de Zoonoses, Rio de Janeiro, Brazil
- Superintendência de Informações Estratégicas de Vigilância em Saúde (SIEVS/RJ), Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Flávia B Dos Santos
- Laboratório de Imunologia Viral (LIV), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
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Characterization of the IL-17 and CD4+ Th17 Cells in the Clinical Course of Dengue Virus Infections. Viruses 2020; 12:v12121435. [PMID: 33322218 PMCID: PMC7763078 DOI: 10.3390/v12121435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
The aims of this study were to determine the involvement of interleukin 17 (IL-17) and IL-17-producing cells in dengue pathogenesis. Blood samples from dengue virus (DENV)-infected patients were collected on different days after the onset of symptoms. Patients were classified according to 1997 World Health Organization guidelines. Our study examined 152 blood samples from dengue fever (DF, n = 109) and dengue hemorrhagic fever (DHF, n = 43) patients and 90 blood samples from healthy controls (HC). High serum concentrations of IL-17A and IL-22 were also associated with DHF (IL-17A [DHF vs. DF, p < 0.01; DHF vs. HC, p < 0.0001]; IL-22 [DHF vs. DF, p < 0.05; DHF vs. HC, p < 0.0001]). Moreover, there was a positive correlation between serum levels of IL-17A and IL-23, a key cytokine that promotes IL-17-based immune responses (r = 0.4089, p < 0.0001). Consistent with the IL-17-biased immune response in DHF patients, we performed ex vivo activation of peripheral blood mononuclear cells (PBMCs) from DHF patients and flow cytometry analysis showed a robust IL-17-biased immune response, characterized by a high frequency of CD4+IL-17+ producing cells. Our results suggests IL-17-producing cells and their related cytokines can play a prominent role in this viral disease.
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Pushpakumara PD, Jeewandara C, Gomes L, Perera Y, Wijewickrama A, Malavige GN, Goonesekara C. Development and validation of an assay for detection of Japanese encephalitis virus specific antibody responses. PLoS One 2020; 15:e0238609. [PMID: 33112881 PMCID: PMC7592747 DOI: 10.1371/journal.pone.0238609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Although immune responses to the Japanese Encephalitis virus (JEV), and the dengue viruses (DENV) have a potential to modulate the immune responses to each other, this has been poorly investigated. Therefore, we developed an ELISA to identify JEV specific, DENV non cross-reactive antibody responses by identifying JEV specific, highly conserved regions of the virus and proceeded to investigate if the presence of JEV specific antibodies associate with dengue disease severity. Methodology and results 22 JEV specific peptides were identified from highly conserved regions of the virus and the immunogenicity and specificity of these peptides were assessed in individuals who were non-immune to JEV and DENV (JEV-DENV-, N = 30), those who were only immune to the JEV and not DENV (JEV+DENV-, N = 30), those who were only immune to DENV(JEV-DENV+, N = 30) and in those who were immune to both viruses (JEV+DENV+, N = 30). 7/22 peptides were found to be highly immunogenic and specific and these 7 peptides were used as a pool to further evaluate JEV-specific responses. All 30/30 JEV+DENV- and 30/30 JEV+DENV+ individuals, and only 3/30 (10%) JEV-DENV+ individuals responded to this pool. We further evaluated this pool of 7 peptides in patients following primary and secondary dengue infection during the convalescent period and found that the JEV-specific peptides, were unlikely to cross react with DENV IgG antibodies. We further compared this in-house ELISA developed with the peptide pool with an existing commercial JEV IgG assay to identify JEV-specific IgG following vaccination, and our in-house ELISA was found to be more sensitive. We then proceeded to investigate if the presence of JEV-specific antibodies were associated with dengue disease severity, and we found that those who had past severe dengue (n = 175) were significantly more likely (p<0.0001) to have JEV-specific antibodies than those with past non-severe dengue (n = 175) (OR 5.3, 95% CI 3.3 to 8.3). Conclusions As our data show that this assay is highly sensitive and specific for detection of JEV-specific antibody responses, it would be an important tool to determine how JEV seropositivity modulate dengue immunity and disease severity when undertaking dengue vaccine trials.
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Affiliation(s)
| | - Chandima Jeewandara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Laksiri Gomes
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Yashodha Perera
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Rathore APS, Senanayake M, Athapathu AS, Gunasena S, Karunaratna I, Leong WY, Lim T, Mantri CK, Wilder-Smith A, St John AL. Serum chymase levels correlate with severe dengue warning signs and clinical fluid accumulation in hospitalized pediatric patients. Sci Rep 2020; 10:11856. [PMID: 32678248 PMCID: PMC7367272 DOI: 10.1038/s41598-020-68844-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023] Open
Abstract
Dengue induces a spectrum of severity in humans from the milder dengue fever to severe disease, or dengue hemorrhagic fever (DHF). Chymase is a candidate biomarker that may aid dengue prognosis. This prospective study aimed to identify whether warning signs of severe dengue, including hypovolemia and fluid accumulation, were associated with elevated chymase. Serum chymase levels were quantified prospectively and longitudinally in hospitalized pediatric dengue patients in Sri Lanka. Warning signs were determined based on daily clinical assessments, laboratory tests and ultrasound findings. Chymase was significantly elevated during the acute phase of disease in DHF or Severe dengue, defined by either the 1997 or 2009 WHO diagnosis guidelines, and persisted longer in the most severe patients. Chymase levels were higher in patients with narrow pulse pressure and clinical warning signs such as severe leakage, fluid accumulation, pleural effusion, gall-bladder wall thickening and rapid haematocrit rise concurrent with thrombocytopenia. No association between chymase and liver enlargement was observed. This study confirms that serum chymase levels are associated with DHF/Severe dengue disease in hospitalized pediatric patients. Chymase levels correlate with warning signs of vascular dysfunction highlighting the possible functional role of chymase in vascular leakage during dengue.
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Affiliation(s)
- Abhay P S Rathore
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Manouri Senanayake
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.,Lady Ridgeway Children's Hospital, Colombo, Sri Lanka
| | | | - Sunethra Gunasena
- Department of Virology, Medical Research Institute (MRI), Colombo, Sri Lanka
| | | | - Wei Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ting Lim
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore
| | - Chinmay Kumar Mantri
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore
| | - Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ashley L St John
- Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, 8 College Rd., Level 9, Singapore, Singapore. .,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Global Health Institute, Singapore, Singapore.
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Hegazi MA, Bakarman MA, Alahmadi TS, Butt NS, Alqahtani AM, Aljedaani BS, Almajnuni AH. Risk Factors and Predictors of Severe Dengue in Saudi Population in Jeddah, Western Saudi Arabia: A Retrospective Study. Am J Trop Med Hyg 2020; 102:613-621. [PMID: 31933467 DOI: 10.4269/ajtmh.19-0650] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study was performed to determine the risk factors and predictors of severe dengue fever (SDF) in Saudi population in Jeddah, Western Saudi Arabia. This 7-year retrospective study included children and adults with confirmed dengue from 2010 to 2016. Demographic, clinical, laboratory, serological, and virologic data were collected. Comparative analyses were performed between pediatric and adult SDF cases defined according to the WHO 2009 dengue classification. During the study period, dengue was confirmed in 17,646 cases with predominant infection of adults (6.5 times that of children) and males (3.8 times that of females). May and June were associated with 43.9% of total dengue cases. All 56 pediatric and 187 adult SDF cases were hospitalized. At least one warning sign of severe illness was present in 92.2% of total SDF cases. Mortality rates were 8.9% and 10.7% of pediatric and adult SDF cases, respectively. Multiple logistic regression detected that the most significant risk factors and predictors of SDF in adults versus children were significantly more secondary dengue infection (adjusted odds ratio [AOR]: 2.20, 95% CI: 1.09-4.44, P = 0.02), significantly less clinical fluid accumulation (AOR: 0.17, 95% CI: 0.07-0.44, P < 0.001) and significantly less neutropenia (AOR: 0.41, 95% CI: 0.17-0.97, P = 0.04). This was the first large multicenter study evaluating SDF in Saudi population and considering the WHO 2009 dengue classification, which showed predominant infection of adults and males with dengue, few SDF cases with low mortality and highlighted predictors of SDF in adults versus children. Consideration of warning signs for severe dengue may result in hospital admission, prompting closer monitoring, timely and proper interventions and reduced mortality in SDF cases.
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Affiliation(s)
- Moustafa A Hegazi
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marwan A Bakarman
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Turki S Alahmadi
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.,Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nadeem S Butt
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Alqahtani
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Badr S Aljedaani
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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10
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Onyedibe K, Dawurung J, Iroezindu M, Shehu N, Okolo M, Shobowale E, Afolaranmi T, Dahal S, Maktep Y, Pama P, Isa S, Egah D. A cross sectional study of dengue virus infection in febrile patients presumptively diagnosed of malaria in Maiduguri and Jos plateau, Nigeria. Malawi Med J 2019; 30:276-282. [PMID: 31798807 PMCID: PMC6863422 DOI: 10.4314/mmj.v30i4.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Nigeria, where malaria is endemic, greater than 70% of febrile illnesses are treated presumptively as malaria, often without a laboratory evaluation for other possible causes of fever. This cross-sectional study evaluated the presence of dengue virus infection in febrile patients, presumptively diagnosed of malaria infections in the clinic. Methodology Blood samples were collected from 529 febrile patients (246 in Jos and 283 in Maiduguri) attending the general outpatient clinics of the Jos University Teaching Hospital (JUTH) and the University of Maiduguri Teaching Hospital (UMTH) and tested for anti-dengue immunoglobulin M (IgM) and immunoglobulin G (IgG), as well as anti-non-structural protein (NS1) by ELISA. The samples were also evaluated for presence of P. falciparum malaria parasites by microscopic examination of Giemsa-stained blood smears. Results The prevalence of confirmed, highly suggestive and probable dengue virus infections categorized in relation to duration of illness since onset of fever were 2.3%, 5.5% and 1.5% respectively, while the prevalence of anti-flavivirus IgG and IgM seropositivity was 11.7%. In a total of 117 (22.1%) patients (32 in Jos, 85 in Maiduguri), malaria parasites were detected by blood smear microscopy, out of which 7 (6%) also had a positively confirmed, highly suggestive or probable dengue test result. Conclusion Although the high cross-reactivity of anti-flavivirus antibodies should be taken into account in the interpretation of the seroprevalence data, our findings suggest a significant presence of dengue virus in this environment, some of which may otherwise be misdiagnosed as malaria. These findings are strong enough to recommend serological screening for anti-dengue virus titer and NS1 antigen for all febrile patients, as part of fever diagnostic protocols in tropical regions. Given the prevalence of dengue virus infections, there is also a need for a dengue control program and public education to prevent outbreaks and occurrence of severe dengue complications.
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Affiliation(s)
- Kenneth Onyedibe
- Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Joshua Dawurung
- WHO National Polio/Infectious and tropical Diseases Laboratory, University of Maiduguri Teaching hospital, Maiduguri, Nigeria
| | - Michael Iroezindu
- Infectious Diseases/Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, PMB 01129, Ituku/Ozalla, Enugu, Nigeria
| | - Nathan Shehu
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Mark Okolo
- Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Emmanuel Shobowale
- Department of Medical Microbiology, Ben Carson School of Medicine, Babcock University, Ogun State, Nigeria
| | | | - Samuel Dahal
- Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Yadang Maktep
- Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Peter Pama
- Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Samson Isa
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
| | - Daniel Egah
- Department of Medical Microbiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria
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11
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Sule WF, Fadamitan TO, Lawal OA, Adebimpe WO, Opaleye OO, Oluwayelu DO. Probable primary and secondary dengue viral infections and associated host factors among university undergraduates in Osun State, Nigeria. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1080/20905068.2019.1592935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Waidi F. Sule
- Department of Microbiology, Faculty of Basic and Applied Sciences, Osun State University, Osogbo, Nigeria
| | - Toluwani O. Fadamitan
- Department of Microbiology, Faculty of Basic and Applied Sciences, Osun State University, Osogbo, Nigeria
| | - Omotayo A. Lawal
- Department of Microbiology, Faculty of Basic and Applied Sciences, Osun State University, Osogbo, Nigeria
| | - Wasiu O. Adebimpe
- Department of Community Medicine, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Nigeria
| | - Oluyinka O. Opaleye
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria
| | - Daniel O. Oluwayelu
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
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12
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Auerswald H, de Jesus A, Seixas G, Nazareth T, In S, Mao S, Duong V, Silva AC, Paul R, Dussart P, Sousa CA. First dengue virus seroprevalence study on Madeira Island after the 2012 outbreak indicates unreported dengue circulation. Parasit Vectors 2019; 12:103. [PMID: 30867031 PMCID: PMC6417143 DOI: 10.1186/s13071-019-3357-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background In 2012, the first dengue virus outbreak was reported on the Portuguese island of Madeira with 1080 confirmed cases. Dengue virus of serotype 1 (DENV-1), probably imported from Venezuela, caused this outbreak with autochthonous transmission by invasive Aedes aegypti mosquitoes. Results We investigated the seroprevalence among the population on Madeira Island four years after the outbreak. Study participants (n = 358), representative of the island population regarding their age and gender, were enrolled in 2012 in a cross-sectional study. Dengue antibodies were detected with an in-house enzyme-linked immunosorbent assay (ELISA) using the dimer of domain III (ED3) of the DENV-1 envelope protein as well as commercial Panbio indirect and capture IgG ELISAs. Positive ELISA results were validated with a neutralization test. The overall seroprevalence was found to be 7.8% (28/358) with the in-house ELISA, whereas the commercial DENV indirect ELISA detected IgG antibodies in 8.9% of the individuals (32/358). The results of the foci reduction neutralization test confirmed DENV-1 imported from South America as the causative agent of the 2012 epidemic. Additionally, we found a higher seroprevalence in study participants with an age above 60 years old and probable secondary DENV infected individuals indicating unreported dengue circulation before or after 2012 on Madeira Island. Conclusions This study revealed that the number of infections might have been much higher than estimated from only confirmed cases in 2012/2013. These mainly DENV-1 immune individuals are not protected from a secondary DENV infection and the majority of the population of Madeira Island is still naïve for DENV. Surveillance of mosquitoes and arboviruses should be continued on Madeira Island as well as in other European areas where invasive vector mosquitoes are present. Electronic supplementary material The online version of this article (10.1186/s13071-019-3357-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Auerswald
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Ana de Jesus
- GHTM-Global Health and Tropical Medicine, 1349-008, Lisbon, Portugal.,UEI Medical Parasitology, Institute of Hygiene and Tropical Medicine of Lisbon, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Gonçalo Seixas
- GHTM-Global Health and Tropical Medicine, 1349-008, Lisbon, Portugal.,UEI Medical Parasitology, Institute of Hygiene and Tropical Medicine of Lisbon, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teresa Nazareth
- GHTM-Global Health and Tropical Medicine, 1349-008, Lisbon, Portugal.,UEI Medical Parasitology, Institute of Hygiene and Tropical Medicine of Lisbon, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Saraden In
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Sokthearom Mao
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia
| | - Ana Clara Silva
- Departamento de Saúde, Planeamento e Administração Geral, Instituto de Administração da Saúde e Assuntos Sociais, IP-RAM, Funchal, Madeira, Portugal.,Madeira Regional Government, Institute of Health and Social Affairs, Av. Zarco, Funchal, Madeira, Portugal
| | - Richard Paul
- Functional Genetics of Infectious Diseases Unit, Department of Genomes and Genetics, Institut Pasteur, 75015, Paris, France.,Génomique évolutive, modélisation et santé UMR 2000, Centre National de la Recherche Scientifique (CNRS), 75724, Paris Cedex 15, France
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, PO Box 983, Phnom Penh, Cambodia.
| | - Carla Alexandra Sousa
- GHTM-Global Health and Tropical Medicine, 1349-008, Lisbon, Portugal.,UEI Medical Parasitology, Institute of Hygiene and Tropical Medicine of Lisbon, Universidade Nova de Lisboa, Lisbon, Portugal
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13
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Role of NS1 antibodies in the pathogenesis of acute secondary dengue infection. Nat Commun 2018; 9:5242. [PMID: 30531923 PMCID: PMC6286345 DOI: 10.1038/s41467-018-07667-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/13/2018] [Indexed: 12/16/2022] Open
Abstract
The role of NS1-specific antibodies in the pathogenesis of dengue virus infection is poorly understood. Here we investigate the immunoglobulin responses of patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) to NS1. Antibody responses to recombinant-NS1 are assessed in serum samples throughout illness of patients with acute secondary DENV1 and DENV2 infection by ELISA. NS1 antibody titres are significantly higher in patients with DHF compared to those with DF for both serotypes, during the critical phase of illness. Furthermore, during both acute secondary DENV1 and DENV2 infection, the antibody repertoire of DF and DHF patients is directed towards distinct regions of the NS1 protein. In addition, healthy individuals, with past non-severe dengue infection have a similar antibody repertoire as those with mild acute infection (DF). Therefore, antibodies that target specific NS1 epitopes could predict disease severity and be of potential benefit in aiding vaccine and treatment design. The antibody response during infection with dengue virus is a key component involved in the pathogenesis during secondary infection. Here the authors show antibodies targeting NS1 and the epitopes targeted can be associated with disease severity during human infection.
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14
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Wijeratne DT, Fernando S, Gomes L, Jeewandara C, Ginneliya A, Samarasekara S, Wijewickrama A, Hardman CS, Ogg GS, Malavige GN. Quantification of dengue virus specific T cell responses and correlation with viral load and clinical disease severity in acute dengue infection. PLoS Negl Trop Dis 2018; 12:e0006540. [PMID: 30273352 PMCID: PMC6181435 DOI: 10.1371/journal.pntd.0006540] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/11/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background In order to understand the role of dengue virus (DENV) specific T cell responses that associate with protection, we studied their frequency and phenotype in relation to clinical disease severity and resolution of viraemia in a large cohort of patients with varying severity of acute dengue infection. Methodology/Principal findings Using ex vivo IFNγ ELISpot assays we determined the frequency of dengue viral peptide (DENV)-NS3, NS1 and NS5 responsive T cells in 74 adult patients with acute dengue infection and examined the association of responsive T cell frequency with the extent of viraemia and clinical disease severity. We found that total DENV-specific and DENV-NS3-specific T cell responses, were higher in patients with dengue fever (DF), when compared to those with dengue haemorrhagic fever (DHF). In addition, those with DF had significantly higher (p = 0.02) DENV-specific T cell responses on day 4 of infection compared to those who subsequently developed DHF. DENV peptide specific T cell responses inversely correlated with the degree of viraemia, which was most significant for DENV-NS3 specific T cell responses (Spearman’s r = -0.47, p = 0.0003). The frequency of T cell responses to NS1, NS5 and pooled DENV peptides, correlated with the degree of thrombocytopenia but had no association with levels of liver transaminases. In contrast, total DENV-IgG inversely correlated with the degree of thrombocytopenia and levels of liver transaminases. Conclusions/Significance Early appearance of DENV-specific T cell IFNγ responses before the onset of plasma leakage, appears to associate with milder clinical disease and resolution of viraemia, suggesting a protective role in acute dengue infection. In order to understand the role of dengue virus (DENV) specific T cell responses in protection against infection, we studied T cell cytokine production in relation to clinical disease severity and resolution of viraemia in a large cohort of patients with varying severity of acute dengue infection. We found that DENV-specific T cell responses were higher in patients with dengue fever, when compared to those with dengue haemorrhagic fever. In addition, early appearance of DENV-specific T cell responses was significantly associated with milder clinical disease (p = 0.02). DENV peptide specific T cell responses inversely correlated with the degree of viraemia, which was most significant for DENV-NS3 specific T cell responses (Spearman’s r = -0.47, p = 0.0003). The frequency of NS1, NS5 and pooled DENV peptides, correlated with the degree of thrombocytopenia but had no association with liver transaminases. Our data suggest that early appearance of DENV-specific T cell IFNγ responses appear to associate with milder clinical disease and resolution of viraemia, suggesting a protective role in acute dengue infection.
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Affiliation(s)
| | - Samitha Fernando
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Laksiri Gomes
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Chandima Jeewandara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Anushka Ginneliya
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Supun Samarasekara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Clare S. Hardman
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Graham S. Ogg
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gathsaurie Neelika Malavige
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail:
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15
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Nguyen THT, Clapham HE, Phung KL, Nguyen TK, DInh TT, Nguyen THQ, Tran VN, Whitehead S, Simmons C, Wolbers M, Wills B. Methods to discriminate primary from secondary dengue during acute symptomatic infection. BMC Infect Dis 2018; 18:375. [PMID: 30086716 PMCID: PMC6081805 DOI: 10.1186/s12879-018-3274-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dengue virus infection results in a broad spectrum of clinical outcomes, ranging from asymptomatic infection through to severe dengue. Although prior infection with another viral serotype, i.e. secondary dengue, is known to be an important factor influencing disease severity, current methods to determine primary versus secondary immune status during the acute illness do not consider the rapidly evolving immune response, and their accuracy has rarely been evaluated against an independent gold standard. METHODS Two hundred and ninety-three confirmed dengue patients were classified as experiencing primary, secondary or indeterminate infections using plaque reduction neutralisation tests performed 6 months after resolution of the acute illness. We developed and validated regression models to differentiate primary from secondary dengue on multiple acute illness days, using Panbio Indirect IgG and in-house capture IgG and IgM ELISA measurements performed on over 1000 serial samples obtained during acute illness. RESULTS Cut-offs derived for the various parameters demonstrated progressive change (positively or negatively) by day of illness. Using these time varying cut-offs it was possible to determine whether an infection was primary or secondary on single specimens, with acceptable performance. The model using Panbio Indirect IgG responses and including an interaction with illness day showed the best performance throughout, although with some decline in performance later in infection. Models based on in-house capture IgG levels, and the IgM/IgG ratio, also performed well, though conversely performance improved later in infection. CONCLUSIONS For all assays, the best fitting models estimated a different cut-off value for different days of illness, confirming how rapidly the immune response changes during acute dengue. The optimal choice of assay will vary depending on circumstance. Although the Panbio Indirect IgG model performs best early on, the IgM/IgG capture ratio may be preferred later in the illness course.
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Affiliation(s)
- Thi Hanh Tien Nguyen
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Hannah E. Clapham
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Khanh Lam Phung
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Thanh Kieu Nguyen
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - The Trung DInh
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Than Ha Quyen Nguyen
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Van Ngoc Tran
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Stephen Whitehead
- Laboratory of Infectious Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, MD USA
| | - Cameron Simmons
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Nossal Institute of Global Health, School of Population and Global Health, University of Melbourne, Parkville, VIC Australia
| | - Marcel Wolbers
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bridget Wills
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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16
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Jayaratne HE, Wijeratne D, Fernando S, Kamaladasa A, Gomes L, Wijewickrama A, Ogg GS, Malavige GN. Regulatory T-cells in acute dengue viral infection. Immunology 2018; 154:89-97. [PMID: 29140541 PMCID: PMC5904698 DOI: 10.1111/imm.12863] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/04/2017] [Indexed: 12/25/2022] Open
Abstract
Although regulatory T-cells (Tregs ) have been shown to be expanded in acute dengue, their role in pathogenesis and their relationship to clinical disease severity and extent of viraemia have not been fully evaluated. The frequency of Tregs was assessed in 56 adult patients with acute dengue by determining the proportion of forkhead box protein 3 (FoxP3) expressing CD4+ CD25+ T-cells (FoxP3+ cells). Dengue virus (DENV) viral loads were measured by quantitative real-time polymerase chain reaction (PCR) and DENV-specific T-cell responses were measured by ex-vivo interferon (IFN)-γ enzyme-linked immunospot (ELISPOT) assays to overlapping peptide pools of DENV-NS3, NS1 and NS5. CD45RA and CCR4 were used to phenotype different subsets of T-cells and their suppressive potential was assessed by their expression of cytotoxic T lymphocyte-antigen 4 (CTLA-4) and Fas. While the frequency of FoxP3+ cells in patients was significantly higher (P < 0·0001) when compared to healthy individuals, they did not show any relationship with clinical disease severity or the degree of viraemia. The frequency of FoxP3+ cells did not correlate with either ex-vivo IFN-γ DENV-NS3-, NS5- or NS1-specific T-cell responses. FoxP3+ cells of patients with acute dengue were predominantly CD45RA+ FoxP3low , followed by CD45RA-FoxP3low , with only a small proportion of FoxP3+ cells being of the highly suppressive effector Treg subtype. Expression of CCR4 was also low in the majority of T-cells, with only CCR4 only being expressed at high levels in the effector Treg population. Therefore, although FoxP3+ cells are expanded in acute dengue, they predominantly consist of naive Tregs , with poor suppressive capacity.
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Affiliation(s)
| | - Dulharie Wijeratne
- Centre for Dengue ResearchUniversity of Sri JayewardenepuraColomboSri Lanka
| | - Samitha Fernando
- Centre for Dengue ResearchUniversity of Sri JayewardenepuraColomboSri Lanka
| | - Achala Kamaladasa
- Centre for Dengue ResearchUniversity of Sri JayewardenepuraColomboSri Lanka
| | - Laksiri Gomes
- Centre for Dengue ResearchUniversity of Sri JayewardenepuraColomboSri Lanka
| | | | - Graham Stuart Ogg
- MRC Human Immunology UnitWeatherall Institute of Molecular MedicineOxfordUK
| | - Gathsaurie Neelika Malavige
- Centre for Dengue ResearchUniversity of Sri JayewardenepuraColomboSri Lanka
- MRC Human Immunology UnitWeatherall Institute of Molecular MedicineOxfordUK
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17
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Reliable Serological Testing for the Diagnosis of Emerging Infectious Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1062:19-43. [PMID: 29845523 DOI: 10.1007/978-981-10-8727-1_3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Climate change, increased urbanization and international travel have facilitated the spread of mosquito vectors and the viral species they carry. Zika virus (ZIKV) is currently spreading in the Americas, while dengue virus (DENV) and chikungunya virus (CHIKV) have already become firmly established in most tropical and also many non-tropical regions. ZIKV, DENV and CHIKV overlap in their endemic areas and cause similar clinical symptoms, especially in the initial stages of infection. Infections with each of these viruses can lead to severe complications, and co-infections have been reported. Therefore, laboratory analyses play an important role in differential diagnostics. A timely and accurate diagnosis is crucial for patient management, prevention of unnecessary therapies, rapid adoption of vector control measures, and collection of epidemiological data.There are two pillars to diagnosis: direct pathogen detection and the determination of specific antibodies. Serological tests provide a longer diagnostic window than direct methods, and are suitable for diagnosing acute and past infections, for disease surveillance and for vaccination monitoring. ELISA and indirect immunofluorescence test (IIFT) systems based on optimized antigens enable sensitive and specific detection of antibodies against ZIKV, DENV and CHIKV in patient serum or plasma. In recent years, Euroimmun (Lübeck, Germany) has developed numerous test systems for the serological diagnosis of (re-)emerging diseases, including a very sensitive and specific anti-ZIKV ELISA.
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18
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Rotolo ML, Giménez-Lirola L, Ji J, Magtoto R, Henao-Díaz YA, Wang C, Baum DH, Harmon KM, Main RG, Zimmerman JJ. Detection of porcine reproductive and respiratory syndrome virus (PRRSV)-specific IgM-IgA in oral fluid samples reveals PRRSV infection in the presence of maternal antibody. Vet Microbiol 2017; 214:13-20. [PMID: 29408024 DOI: 10.1016/j.vetmic.2017.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 01/21/2023]
Abstract
The ontogeny of PRRSV antibody in oral fluids has been described using isotype-specific ELISAs. Mirroring the serum response, IgM appears in oral fluid by 7days post inoculation (DPI), IgA after 7 DPI, and IgG by 9 to 10 DPI. Commercial PRRSV ELISAs target the detection of IgG because the higher concentration of IgG relative to other isotypes provides the best diagnostic discrimination. Oral fluids are increasingly used for PRRSV surveillance in commercial herds, but in younger pigs, a positive ELISA result may be due either to maternal antibody or to antibody produced by the pigs in response to infection. To address this issue, a combined IgM-IgA PRRSV oral fluid ELISA was developed and evaluated for its capacity to detect pig-derived PRRSV antibody in the presence of maternal antibody. Two longitudinal studies were conducted. In Study 1 (modified-live PRRS vaccinated pigs), testing of individual pig oral fluid samples by isotype-specific ELISAs demonstrated that the combined IgM-IgA PRRSV ELISA provided better discrimination than individual IgM or IgA ELISAs. In Study 2 (field data), testing of pen-based oral fluid samples confirmed the findings in Study 1 and established that the IgM-IgA ELISA was able to detect antibody produced by pigs in response to wild-type PRRSV infection, despite the presence of maternal IgG. Overall, the combined PRRSV IgM-IgA oral fluid ELISA described in this study is a potential tool for PRRSV surveillance, particularly in populations of growing pigs originating from PRRSV-positive or vaccinated breeding herds.
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Affiliation(s)
- Marisa L Rotolo
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA.
| | - Luis Giménez-Lirola
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Ju Ji
- Department of Statistics, College of Liberal Arts and Sciences, Iowa State University, Ames, IA, USA
| | - Ronaldo Magtoto
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Yuly A Henao-Díaz
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Chong Wang
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA; Department of Statistics, College of Liberal Arts and Sciences, Iowa State University, Ames, IA, USA
| | - David H Baum
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Karen M Harmon
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Rodger G Main
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Jeffrey J Zimmerman
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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Tsai WY, Youn HH, Brites C, Tsai JJ, Tyson J, Pedroso C, Drexler JF, Stone M, Simmons G, Busch MP, Lanteri M, Stramer SL, Balmaseda A, Harris E, Wang WK. Distinguishing Secondary Dengue Virus Infection From Zika Virus Infection With Previous Dengue by a Combination of 3 Simple Serological Tests. Clin Infect Dis 2017; 65:1829-1836. [PMID: 29020159 PMCID: PMC5850648 DOI: 10.1093/cid/cix672] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/27/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The explosive spread of Zika virus (ZIKV) and associated microcephaly present an urgent need for sensitive and specific serodiagnostic tests, particularly for pregnant women in dengue virus (DENV)-endemic regions. Recent reports of enhanced ZIKV replication by dengue-immune sera have raised concerns about the role of previous DENV infection on the risk and severity of microcephaly and other ZIKV complications. METHODS Enzyme-linked immunosorbent assays (ELISAs) based on ZIKV and DENV nonstructural protein 1 (NS1) were established to test acute, convalescent phase, and post-convalescent phase serum/plasma samples from reverse-transcription polymerase chain reaction-confirmed cases including 20 primary ZIKV, 25 ZIKV with previous DENV, 58 secondary DENV, and 16 primary DENV1 infections. RESULTS ZIKV-NS1 immunoglobulin M (IgM) and immunoglobulin G (IgG) ELISAs combined can detect ZIKV infection with a sensitivity of 95% and specificity of 66.7%. The ZIKV-NS1 IgG cross-reactivity by samples from secondary DENV infection cases ranged from 66.7% to 28.1% (within 1 month to 1-2 years post-illness, respectively). Addition of DENV1-NS1 IgG ELISA can distinguish primary ZIKV infection; the ratio of absorbance of ZIKV-NS1 to DENV1-NS1 IgG ELISA can distinguish ZIKV with previous DENV and secondary DENV infections with a sensitivity of 87.5% and specificity of 81.3%. These findings were supported by analysis of sequential samples. CONCLUSIONS An algorithm for ZIKV serodiagnosis based on 3 simple ELISAs is proposed to distinguish primary ZIKV, ZIKV with previous DENV, and secondary DENV infections; this could be applied to serodiagnosis for ZIKV, serosurveillance, and monitoring ZIKV infection during pregnancy to understand the epidemiology, pathogenesis, and complications of ZIKV in dengue-endemic regions.
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Affiliation(s)
- Wen-Yang Tsai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
| | - Han Ha Youn
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
| | - Carlos Brites
- Laboratory of Infection Research, School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Jih-Jin Tsai
- Divison of Infectious Diseases
- Department of Internal Medicine and Tropical Medicine Center, Kaohsiung Medical University Hospital
- Department of Medicine, College of Medicine
- Center for Dengue Fever Control and Research, Kaohsiung Medical University, Taiwan
| | - Jasmine Tyson
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
| | - Celia Pedroso
- Laboratory of Infection Research, School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Jan Felix Drexler
- University of Bonn Medical Centre, Institute of Virology
- German Centre for Infection Research, Bonn-Cologne, Germany
| | | | - Graham Simmons
- Blood Systems Research Institute
- University of California, San Francisco
| | - Michael P Busch
- Blood Systems Research Institute
- University of California, San Francisco
| | - Marion Lanteri
- Blood Systems Research Institute
- University of California, San Francisco
| | - Susan L Stramer
- American Red Cross Scientific Support Office, Gaithersburg, Maryland
| | - Angel Balmaseda
- National Virology Laboratory, National Center for Diagnosis and Reference, Ministry of Health, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
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20
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Tsai WY, Lin HE, Wang WK. Complexity of Human Antibody Response to Dengue Virus: Implication for Vaccine Development. Front Microbiol 2017; 8:1372. [PMID: 28775720 PMCID: PMC5517401 DOI: 10.3389/fmicb.2017.01372] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/06/2017] [Indexed: 01/21/2023] Open
Abstract
The four serotypes of dengue virus (DENV) are the leading cause of arboviral diseases in humans. Decades of efforts have made remarkable progress in dengue vaccine development. Despite the first dengue vaccine (dengvaxia from Sanofi Pasteur), a live-attenuated tetravalent chimeric yellow fever-dengue vaccine, has been licensed by several countries since 2016, its overall moderate efficacy (56.5–60.8%) in the presence of neutralizing antibodies during the Phase 2b and 3 trials, lower efficacy among dengue naïve compared with dengue experienced individuals, and increased risk of hospitalization among young children during the follow-up highlight the need for a better understanding of humoral responses after natural DENV infection. Recent studies of more than 300 human monoclonal antibodies (mAbs) against DENV have led to the discovery of several novel epitopes on the envelope protein recognized by potent neutralizing mAbs. This information together with in-depth studies on polyclonal sera and B-cells following natural DENV infection has tremendous implications for better immunogen design for a safe and effective dengue vaccine. This review outlines the progress in our understanding of mouse mAbs, human mAbs, and polyclonal sera against DENV envelope and precursor membrane proteins, two surface proteins involved in vaccine development, following natural infection; analyses of these discoveries have provided valuable insight into new strategies involving molecular technology to induce more potent neutralizing antibodies and less enhancing antibodies for next-generation dengue vaccine development.
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Affiliation(s)
- Wen-Yang Tsai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at ManoaHonolulu, HI, United States
| | - Hong-En Lin
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at ManoaHonolulu, HI, United States
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at ManoaHonolulu, HI, United States
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21
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Sriprapun M, Laosakul C, Krajiw S, Arunyingmongkol K, Siriyasatien P, Kulwichit W. Time course of concurrent infection with dengue virus serotypes 2 and 4 detected in urine. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0902.387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
In hyperendemic areas, concurrent multiserotype dengue virus (DENV) infections commonly occur in both humans and in mosquito vectors. Previous studies have focused on single blood specimens.
Objectives
To illustrate and characterize the time course of mixed infection with DENV serotypes 2 (DENV2) and 4 (DENV4) in a single case.
Materials and methods
Plasma, saliva, and urine were collected from a patient diagnosed with dengue hemorrhagic fever grade II and secondary DENV infection on days 7, 18, and 31 of his illness. DENV RNA detection was performed using 2 DENV-specific reverse transcriptase-polymerase chain reaction protocols. Cloning and sequencing were performed to quantify the major and minor viral populations in dual-serotype-infected specimen(s). Genotypes of both DENV serotypes were characterized.
Results
DENV genome was detected in plasma and saliva only at the first time point (day 7 of illness), but in urine at both the first and second time points (days 7 and 18 of illness). DENV4 serotype was found in all DENV genome-positive specimens. DENV2 serotype was unexpectedly also detected in the first urine specimen. DENV4 as the major and DENV2 as the minor population. The DENV2 serotype was clustered in genotype Asian I and DENV4 serotype in genotype I.
Conclusion
To our knowledge, this is the first report of concurrent multiserotype DENV infection detected solely in urine. Prospective noninvasive investigations may determine the prevalence of this phenomenon. Clinical and public health implications of this finding need to be explored.
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Affiliation(s)
- Methee Sriprapun
- Interdisciplinary Program of Biomedical Sciences , Faculty of Graduate School , Chulalongkorn University , Bangkok 10330 , Thailand
- King Chulalongkorn Memorial Hospital Clinical Excellence Center for Infectious Diseases of National Concern , Bangkok 10330 , Thailand
- Department of Medicine , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Chalinee Laosakul
- King Chulalongkorn Memorial Hospital Clinical Excellence Center for Infectious Diseases of National Concern , Bangkok 10330 , Thailand
- Department of Medicine , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Sunisa Krajiw
- King Chulalongkorn Memorial Hospital Clinical Excellence Center for Infectious Diseases of National Concern , Bangkok 10330 , Thailand
- Department of Medicine , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Kesinee Arunyingmongkol
- King Chulalongkorn Memorial Hospital Clinical Excellence Center for Infectious Diseases of National Concern , Bangkok 10330 , Thailand
- Department of Medicine , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Padet Siriyasatien
- King Chulalongkorn Memorial Hospital Clinical Excellence Center for Infectious Diseases of National Concern , Bangkok 10330 , Thailand
- Department of Parasitology , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Wanla Kulwichit
- King Chulalongkorn Memorial Hospital Clinical Excellence Center for Infectious Diseases of National Concern , Bangkok 10330 , Thailand
- Department of Medicine , Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
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22
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Jeewandara C, Gomes L, Udari S, Paranavitane SA, Shyamali NLA, Ogg GS, Malavige GN. Secretory phospholipase A2 in the pathogenesis of acute dengue infection. IMMUNITY INFLAMMATION AND DISEASE 2016; 5:7-15. [PMID: 28250920 PMCID: PMC5322161 DOI: 10.1002/iid3.135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 12/15/2022]
Abstract
Introduction Platelet activating factor (PAF) is an important mediator of vascular leak in acute dengue. Phospholipase A2s (PLA2) are inflammatory lipid enzymes that generate and regulate PAF and other mediators associated with mast cells. We sought to investigate if mast cell activation and increases in secretory sPLA2s are associated with an increase in PAF and occurrence of dengue haemorrhagic fever (DHF). Methods The changes in the levels of mast cell tryptase, PAF and the activity of sPLA2 were determined throughout the course of illness in 13 adult patients with DHF, and 30 patients with dengue fever (DF). Results We found that sPLA2 activity was significantly higher in patients with DHF when compared to those with DF, during the first 120 h of clinical illness. sPLA2 activity was significantly associated with PAF levels, which were also significantly higher in patients with DHF. Although levels of mast cell tryptase were higher in patients with DHF, the difference was not significant, and the levels were not above the reference ranges. sPLA2 activity significantly correlated with the degree of viraemia in patients with DHF but not in those with DF. Conclusion sPLA2 appears to play an important role in the pathogenesis of dengue. Since its activity is significantly increased during the early phase of infection in patients with DHF, this suggests that understanding the underlying mechanisms may provide opportunities for early intervention.
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Affiliation(s)
| | - Laksiri Gomes
- Centre for Dengue Research University of Sri Jayawardanapura Sri Lanka
| | - Sukhitha Udari
- Centre for Dengue Research University of Sri Jayawardanapura Sri Lanka
| | - S A Paranavitane
- Centre for Dengue Research University of Sri Jayawardanapura Sri Lanka
| | - N L A Shyamali
- Faculty of Medical Sciences Department of Medicine University of Sri Jayawardanapura Sri Lanka
| | - Graham S Ogg
- MRC Human Immunology Unit NIHR Biomedical Research Centre Weatherall Institute of Molecular Medicine Oxford
| | - Gathsaurie Neelika Malavige
- Centre for Dengue ResearchUniversity of Sri JayawardanapuraSri Lanka; MRC Human Immunology UnitNIHR Biomedical Research CentreWeatherall Institute of Molecular MedicineOxford
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Differentiating secondary from primary dengue using IgG to IgM ratio in early dengue: an observational hospital based clinico-serological study from North India. BMC Infect Dis 2016; 16:715. [PMID: 27894268 PMCID: PMC5127094 DOI: 10.1186/s12879-016-2053-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/21/2016] [Indexed: 11/03/2022] Open
Abstract
Background Secondary dengue causes more severe disease than the primary. Early on, it is important to differentiate the two. We tried to find important clinical and laboratory differences between the two for the purpose of early differentiation. Methods One hundred fourteen patients confirmed on reverse transcriptase-polymerase chain reaction (RT PCR) were studied. On day 2 of illness IgM and IgG indices were studied for calculation of IgG/IgM ratio. A one-step immunochromatographic assay was used for classification of patients into primary and secondary dengue. Patient characteristics were also studied. Results Dengue serotype 1 was the most common found in 60.5% patients. 66.7% (76 patients) had secondary dengue. Secondary dengue cases had a higher mean temperature (101.56 ± 1.55 vs. 100.79 ± 1.25,°F, p 0.015), lower platelet counts (50.51 ± 38.91 vs. 100.45 ± 38.66, x 103/micl, p <0.0001) and a significantly higher percentage of Dengue hemorrhagic fever/Dengue shock syndrome (38.2% vs. 2.6%, p <0.0001). In early phase of dengue NS1 and PCR were found to be better tests for diagnosis and later IgM is better. The IgG/IgM ratio of ≥ 1.10 had a sensitivity of 100%, specificity of 97.4% and accuracy of 67.5% in differentiating secondary from primary dengue. Conclusion Early on in the clinical course, IgG/ IgM ratio can play an important role to differentiate the two. We found the ratio of ≥ 1.10 to be the best cut off for the same.
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Parra B, Lizarazo J, Jiménez-Arango JA, Zea-Vera AF, González-Manrique G, Vargas J, Angarita JA, Zuñiga G, Lopez-Gonzalez R, Beltran CL, Rizcala KH, Morales MT, Pacheco O, Ospina ML, Kumar A, Cornblath DR, Muñoz LS, Osorio L, Barreras P, Pardo CA. Guillain-Barré Syndrome Associated with Zika Virus Infection in Colombia. N Engl J Med 2016; 375:1513-1523. [PMID: 27705091 DOI: 10.1056/nejmoa1605564] [Citation(s) in RCA: 390] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Zika virus (ZIKV) infection has been linked to the Guillain-Barré syndrome. From November 2015 through March 2016, clusters of cases of the Guillain-Barré syndrome were observed during the outbreak of ZIKV infection in Colombia. We characterized the clinical features of cases of Guillain-Barré syndrome in the context of this ZIKV infection outbreak and investigated their relationship with ZIKV infection. METHODS A total of 68 patients with the Guillain-Barré syndrome at six Colombian hospitals were evaluated clinically, and virologic studies were completed for 42 of the patients. We performed reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays for ZIKV in blood, cerebrospinal fluid, and urine, as well as antiflavivirus antibody assays. RESULTS A total of 66 patients (97%) had symptoms compatible with ZIKV infection before the onset of the Guillain-Barré syndrome. The median period between the onset of symptoms of ZIKV infection and symptoms of the Guillain-Barré syndrome was 7 days (interquartile range, 3 to 10). Among the 68 patients with the Guillain-Barré syndrome, 50% were found to have bilateral facial paralysis on examination. Among 46 patients in whom nerve-conduction studies and electromyography were performed, the results in 36 patients (78%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the Guillain-Barré syndrome. Among the 42 patients who had samples tested for ZIKV by RT-PCR, the results were positive in 17 patients (40%). Most of the positive RT-PCR results were in urine samples (in 16 of the 17 patients with positive RT-PCR results), although 3 samples of cerebrospinal fluid were also positive. In 18 of 42 patients (43%) with the Guillain-Barré syndrome who underwent laboratory testing, the presence of ZIKV infection was supported by clinical and immunologic findings. In 20 of these 42 patients (48%), the Guillain-Barré syndrome had a parainfectious onset. All patients tested were negative for dengue virus infection as assessed by RT-PCR. CONCLUSIONS The evidence of ZIKV infection documented by RT-PCR among patients with the Guillain-Barré syndrome during the outbreak of ZIKV infection in Colombia lends support to the role of the infection in the development of the Guillain-Barré syndrome. (Funded by the Bart McLean Fund for Neuroimmunology Research and others.).
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Affiliation(s)
- Beatriz Parra
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Jairo Lizarazo
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Jorge A Jiménez-Arango
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Andrés F Zea-Vera
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Guillermo González-Manrique
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - José Vargas
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Jorge A Angarita
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Gonzalo Zuñiga
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Reydmar Lopez-Gonzalez
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Cindy L Beltran
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Karen H Rizcala
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Maria T Morales
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Oscar Pacheco
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Martha L Ospina
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Anupama Kumar
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - David R Cornblath
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Laura S Muñoz
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Lyda Osorio
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Paula Barreras
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Carlos A Pardo
- From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore
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25
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Kamaladasa A, Gomes L, Jeewandara C, Shyamali N, Ogg GS, Malavige GN. Lipopolysaccharide acts synergistically with the dengue virus to induce monocyte production of platelet activating factor and other inflammatory mediators. Antiviral Res 2016; 133:183-90. [DOI: 10.1016/j.antiviral.2016.07.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/24/2016] [Indexed: 01/19/2023]
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26
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Patterns and causes of liver involvement in acute dengue infection. BMC Infect Dis 2016; 16:319. [PMID: 27391896 PMCID: PMC4938910 DOI: 10.1186/s12879-016-1656-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/07/2016] [Indexed: 12/14/2022] Open
Abstract
Background Liver involvement in acute dengue infection is frequently observed and sometimes leads to acute liver failure, with fatal outcomes. Many factors are thought to contribute to liver dysfunction, including hypoxic injury due to decreased perfusion, direct damage by the virus and immune mediated injury. In this study, we sought to identify the pattern in the change in liver enzymes throughout the illness and its association with the degree of viraemia, onset and extent of plasma leakage and inflammatory mediators. Methods Serial daily blood samples were obtained from 55 adult patients with acute dengue from the time of admission to discharge and the liver function tests, viral loads and cytokines were assessed. The onset and extent of fluid leakage was measured by daily ultrasound examinations and all clinical and laboratory features were serially recorded. Results Aspartate transaminase (AST), alanine transaminase (ALT) and gamma glutamyl transferase (GGT) levels were elevated in patients with dengue infection throughout the illness. The highest AST levels were seen on day 6 of illness and both AST and GGT levels were significantly higher in patients with severe dengue (SD), when compared to those with non-severe dengue (NSD) on day 5 and 6 of illness. Three patients with SD had AST and ALT values of >1000/IU in the absence of any fluid leakage or a rise in the haematocrit (≥20 %). The peak of the AST levels and the lowest serum albumin levels were seen 24 h before the maximum fluid leakage and 24 h after the peak in viraemia. Both serum IL-10 and IL-17 levels were elevated during early illness and were significantly higher in those with SD when compared to NSD. Conclusion Dengue associated liver injury appears to peak around day 6 and 7. Therefore, liver function tests done at earlier dates might not reflect the extent of liver involvement in acute infection. Since severe liver involvement can occur in the absence of fluid leakage, after the peak viraemia, and since it is associated with high IL-17 and IL-10 levels, possible immune mechanisms leading to hepatic damage should be investigated. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1656-2) contains supplementary material, which is available to authorized users.
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Comparison of the Hemagglutination Inhibition Test and IgG ELISA in Categorizing Primary and Secondary Dengue Infections Based on the Plaque Reduction Neutralization Test. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5253842. [PMID: 27446953 PMCID: PMC4944055 DOI: 10.1155/2016/5253842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/09/2016] [Accepted: 05/26/2016] [Indexed: 11/17/2022]
Abstract
Secondary dengue infection by heterotypic serotypes is associated with severe manifestations of disease, that is, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The World Health Organization (WHO) has recommended criteria based on the hemagglutination inhibition (HI) test to distinguish between primary and secondary dengue infections. Since the HI test has practical limitations and disadvantages, we evaluated the accuracy of WHO HI criteria and compared it with criteria based on an IgG enzyme-linked immunosorbent assay (ELISA) using a plaque reduction neutralization test (PRNT) as the gold standard. Both WHO HI criteria and IgG ELISA criteria performed strongly (16/16) in determining primary infection. However, to determine secondary infection, the IgG ELISA criteria performed better (72/73) compared to the WHO HI criteria (23/73).
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28
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The Use of NS1 Rapid Diagnostic Test and qRT-PCR to Complement IgM ELISA for Improved Dengue Diagnosis from Single Specimen. Sci Rep 2016; 6:27663. [PMID: 27278716 PMCID: PMC4899743 DOI: 10.1038/srep27663] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
Timely and accurate dengue diagnosis is important for differential diagnosis and immediate implementation of appropriate disease control measures. In this study, we compared the usefulness and applicability of NS1 RDT (NS1 Ag Strip) and qRT-PCR tests in complementing the IgM ELISA for dengue diagnosis on single serum specimen (n = 375). The NS1 Ag Strip and qRT-PCR showed a fair concordance (κ = 0.207, p = 0.001). While the NS1 Ag Strip showed higher positivity than qRT-PCR for acute (97.8% vs. 84.8%) and post-acute samples (94.8% vs. 71.8%) of primary infection, qRT-PCR showed higher positivity for acute (58.1% vs. 48.4%) and post-acute (50.0% vs.41.4%) samples in secondary infection. IgM ELISA showed higher positivity in samples from secondary dengue (74.2–94.8%) than in those from primary dengue (21.7–64.1%). More primary dengue samples showed positive with combined NS1 Ag Strip/IgM ELISA (99.0% vs. 92.8%) whereas more secondary samples showed positive with combined qRT-PCR/IgM ELISA (99.4% vs. 96.2%). Combined NS1 Ag Strip/IgM ELISA is a suitable combination tests for timely and accurate dengue diagnosis on single serum specimen. If complemented with qRT-PCR, combined NS1 Ag Strip/IgM ELISA would improve detection of secondary dengue samples.
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29
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Halsey ES, Baldeviano GC, Edgel KA, Vilcarromero S, Sihuincha M, Lescano AG. Symptoms and Immune Markers in Plasmodium/Dengue Virus Co-infection Compared with Mono-infection with Either in Peru. PLoS Negl Trop Dis 2016; 10:e0004646. [PMID: 27128316 PMCID: PMC4851334 DOI: 10.1371/journal.pntd.0004646] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background Malaria and dengue are two of the most common vector-borne diseases in the world, but co-infection is rarely described, and immunologic comparisons of co-infection with mono-infection are lacking. Methodology and Principal Findings We collected symptom histories and blood specimens from subjects in a febrile illness surveillance study conducted in Iquitos and Puerto Maldonado, Peru, between 2002–2011. Nineteen symptoms and 18 immune markers at presentation were compared among those with co-infection with Plasmodium/dengue virus (DENV), Plasmodium mono-infection, and DENV mono-infection. Seventeen subjects were identified as having Plasmodium/DENV co-infection and were retrospectively matched with 51 DENV mono-infected and 44 Plasmodium mono-infected subjects. Those with Plasmodium mono-infection had higher levels of IL-4, IL-6, IL-10, IL-12, IL-13, IL-17A, IFN-γ, and MIP1-α/CCL3 compared with DENV mono-infection or co-infection; those with Plasmodium mono-infection had more cough than those with DENV mono-infection. Subjects with DENV mono-infection had higher levels of TGF-β1 and more myalgia than those with Plasmodium mono-infection. No symptom was more common and no immune marker level was higher in the co-infected group, which had similar findings to the DENV mono-infected subjects. Conclusions/Significance Compared with mono-infection with either pathogen, Plasmodium/DENV co-infection was not associated with worse disease and resembled DENV mono-infection in both symptom frequency and immune marker level. Dengue and malaria are two of the most important diseases spread by mosquitoes. Clinical manifestations of both febrile diseases overlap considerably, and either can be fatal. In addition, they are co-endemic in many places throughout the world. Despite this, only a handful of reports of co-infection with dengue virus and Plasmodium species are reported in the literature. Through our febrile surveillance program in the Peruvian Amazon, we were able to retrospectively identify 17 cases of co-infection with dengue virus and Plasmodium. Our study aimed to assess whether co-infection was associated with more symptoms or a different immune response compared with mono-infection alone. To answer this question, we utilized data and blood specimens collected during the acute presentation of these 17 subjects and compared them to a matched group of subjects with either dengue virus mono-infection or Plasmodium mono-infection. Our findings indicate co-infection with both pathogens was not associated with more symptoms and the immune profile of co-infection resembled dengue virus mono-infection more than Plasmodium mono-infection.
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Affiliation(s)
- Eric S Halsey
- Virology Department, U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru.,The President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.,Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Kimberly A Edgel
- Parasitology Department, U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Stalin Vilcarromero
- Virology Department, U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru
| | - Moises Sihuincha
- Infectious Diseases Department, Hospital de Apoyo, DISA-Loreto, Iquitos, Peru
| | - Andres G Lescano
- Parasitology Department, U.S. Naval Medical Research Unit No. 6, Lima, Peru.,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Singla M, Kar M, Sethi T, Kabra SK, Lodha R, Chandele A, Medigeshi GR. Immune Response to Dengue Virus Infection in Pediatric Patients in New Delhi, India--Association of Viremia, Inflammatory Mediators and Monocytes with Disease Severity. PLoS Negl Trop Dis 2016; 10:e0004497. [PMID: 26982706 PMCID: PMC4794248 DOI: 10.1371/journal.pntd.0004497] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/08/2016] [Indexed: 01/22/2023] Open
Abstract
Dengue virus, a mosquito-borne flavivirus, is a causative agent for dengue infection, which manifests with symptoms ranging from mild fever to fatal dengue shock syndrome. The presence of four serotypes, against which immune cross-protection is short-lived and serotype cross-reactive antibodies that might enhance infection, pose a challenge to further investigate the role of virus and immune response in pathogenesis. We evaluated the viral and immunological factors that correlate with severe dengue disease in a cohort of pediatric dengue patients in New Delhi. Severe dengue disease was observed in both primary and secondary infections. Viral load had no association with disease severity but high viral load correlated with prolonged thrombocytopenia and delayed recovery. Severe dengue cases had low Th1 cytokines and a concurrent increase in the inflammatory mediators such as IL-6, IL-8 and IL-10. A transient increase in CD14+CD16+ intermediate monocytes was observed early in infection. Sorting of monocytes from dengue patient peripheral blood mononuclear cells revealed that it is the CD14+ cells, but not the CD16+ or the T or B cells, that were infected with dengue virus and were major producers of IL-10. Using the Boruta algorithm, reduced interferon-α levels and enhanced aforementioned pro-inflammatory cytokines were identified as some of the distinctive markers of severe dengue. Furthermore, the reduction in the levels of IL-8 and IL-10 were identified as the most significant markers of recovery from severe disease. Our results provide further insights into the immune response of children to primary and secondary dengue infection and help us to understand the complex interplay between the intrinsic factors in dengue pathogenesis. Dengue virus is a human pathogen that causes dengue fever, which can either resolve after mild fever or lead to severe dengue hemorrhagic fever/dengue shock syndrome. The role of dengue virus levels in the blood and the kinetics of infection and immune response that results in severe dengue disease in humans is not well characterized. In this study, we analyzed 97 children with varying degrees of dengue disease, and we show that the dengue virus quantity in blood does not show any significant association with severe disease. However, most severe dengue patients had lower levels of interferons and Th1 cytokines and increased levels of secreted factors such as IL-6, IL-8 and IL-10 that could potentially cause leakage in blood capillaries. Our results indicate that monocytes, which are infected with dengue virus in patients, could possibly play a major role in dengue pathogenesis. Furthermore, using computational analysis we identified association of some of the secreted factors with severe disease and also predicted the markers that could serve as indicators of recovery from severe dengue.
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Affiliation(s)
- Mohit Singla
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Meenakshi Kar
- Vaccine and Infectious Disease Research Center, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | | | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anmol Chandele
- ICGEB-Emory Vaccine Center, ICGEB campus, New Delhi, India
| | - Guruprasad R. Medigeshi
- Vaccine and Infectious Disease Research Center, Translational Health Science and Technology Institute, Faridabad, Haryana, India
- * E-mail:
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31
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Adikari TN, Gomes L, Wickramasinghe N, Salimi M, Wijesiriwardana N, Kamaladasa A, Shyamali NLA, Ogg GS, Malavige GN. Dengue NS1 antigen contributes to disease severity by inducing interleukin (IL)-10 by monocytes. Clin Exp Immunol 2016; 184:90-100. [PMID: 26621477 DOI: 10.1111/cei.12747] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 01/20/2023] Open
Abstract
Both dengue NS1 antigen and serum interleukin (IL)-10 levels have been shown to associate with severe clinical disease in acute dengue infection, and IL-10 has also been shown to suppress dengue-specific T cell responses. Therefore, we proceeded to investigate the mechanisms by which dengue NS1 contributes to disease pathogenesis and if it is associated with altered IL-10 production. Serum IL-10 and dengue NS1 antigen levels were assessed serially in 36 adult Sri Lankan individuals with acute dengue infection. We found that the serum IL-10 levels correlated positively with dengue NS1 antigen levels (Spearman's r = 0·47, P < 0·0001), and NS1 also correlated with annexin V expression by T cells in acute dengue (Spearman's r = 0·63, P = 0·001). However, NS1 levels did not associate with the functionality of T cell responses or with expression of co-stimulatory molecules. Therefore, we further assessed the effect of dengue NS1 on monocytes and T cells by co-culturing primary monocytes and peripheral blood mononuclear cells (PBMC), with varying concentrations of NS1 for up to 96 h. Monocytes co-cultured with NS1 produced high levels of IL-10, with the highest levels seen at 24 h, and then declined gradually. Therefore, our data show that dengue NS1 appears to contribute to pathogenesis of dengue infection by inducing IL-10 production by monocytes.
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Affiliation(s)
- T N Adikari
- Centre for Dengue Research, University of Sri Jayawardanapura, Nugegoda, Sri Lanka
| | - L Gomes
- Centre for Dengue Research, University of Sri Jayawardanapura, Nugegoda, Sri Lanka
| | - N Wickramasinghe
- Centre for Dengue Research, University of Sri Jayawardanapura, Nugegoda, Sri Lanka
| | - M Salimi
- Radcliffe Department of Medicine, MRC Human Immunology Unit, NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, Oxford, UK
| | - N Wijesiriwardana
- Centre for Dengue Research, University of Sri Jayawardanapura, Nugegoda, Sri Lanka
| | - A Kamaladasa
- Centre for Dengue Research, University of Sri Jayawardanapura, Nugegoda, Sri Lanka
| | - N L A Shyamali
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayawardanapura, Nugegoda, Sri Lanka
| | - G S Ogg
- Radcliffe Department of Medicine, MRC Human Immunology Unit, NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, Oxford, UK
| | - G N Malavige
- Centre for Dengue Research, University of Sri Jayawardanapura, Nugegoda, Sri Lanka.,Radcliffe Department of Medicine, MRC Human Immunology Unit, NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, Oxford, UK
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32
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Fernando AN, Malavige GN, Perera KLN, Premawansa S, Ogg GS, De Silva AD. Polymorphisms of Transporter Associated with Antigen Presentation, Tumor Necrosis Factor-α and Interleukin-10 and their Implications for Protection and Susceptibility to Severe Forms of Dengue Fever in Patients in Sri Lanka. J Glob Infect Dis 2016; 7:157-64. [PMID: 26752870 PMCID: PMC4693307 DOI: 10.4103/0974-777x.170501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Context: To date, a clear understanding of dengue disease pathogenesis remains elusive. Some infected individuals display no symptoms while others develop severe life-threatening forms of the disease. It is widely believed that host genetic factors influence dengue severity. Aims: This study evaluates the relationship between certain polymorphisms and dengue severity in Sri Lankan patients. Settings and Design: Polymorphism studies are carried out on genes for; transporter associated with antigen presentation (TAP), promoter of tumor necrosis factor-α (TNF-α), and promoter of interleukin-10 (IL-10). In other populations, TAP1 (333), TAP2 (379), TNF-α (−308), and IL-10 (−1082, −819, −592) have been associated with dengue and a number of different diseases. Data have not been collected previously for these polymorphisms for dengue patients in Sri Lanka. Materials and Methods: The polymorphisms were typed by amplification refractory mutation system polymerase chain reaction in 107 dengue hemorrhagic fever (DHF) patients together with 62 healthy controls. Statistical Analysis Used: Pearson's Chi-square contingency table analysis with Yates′ correction. Results: Neither the TAP nor the IL-10 polymorphisms considered individually can define dengue disease outcome with regard to severity. However, the genotype combination, IL-10 (−592/−819/−1082) CCA/ATA was significantly associated with development of severe dengue in these patients, suggesting a risk factor to developing DHF. Also, identified is the genotype combination IL-10 (−592/−819/−1082) ATA/ATG which suggested a possibility for protection from DHF. The TNF-α (−308) GG genotype was also significantly associated with severe dengue, suggesting a significant risk factor. Conclusions: The results reported here are specific to the Sri Lankan population. Comparisons with previous reports imply that data may vary from population to population.
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Affiliation(s)
| | - Gathsaurie Neelika Malavige
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka; MRC Human Immnology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK
| | | | - Sunil Premawansa
- Department of Zoology, Faculty of Science, University of Colombo, Sri Lanka
| | - Graham S Ogg
- MRC Human Immnology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK
| | - Aruna Dharshan De Silva
- Genetech Research Institute, Colombo 08, Sri Lanka; Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA 92037, USA
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Parkash O, Shueb RH. Diagnosis of Dengue Infection Using Conventional and Biosensor Based Techniques. Viruses 2015; 7:5410-27. [PMID: 26492265 PMCID: PMC4632385 DOI: 10.3390/v7102877] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/01/2015] [Accepted: 09/09/2015] [Indexed: 12/12/2022] Open
Abstract
Dengue is an arthropod-borne viral disease caused by four antigenically different serotypes of dengue virus. This disease is considered as a major public health concern around the world. Currently, there is no licensed vaccine or antiviral drug available for the prevention and treatment of dengue disease. Moreover, clinical features of dengue are indistinguishable from other infectious diseases such as malaria, chikungunya, rickettsia and leptospira. Therefore, prompt and accurate laboratory diagnostic test is urgently required for disease confirmation and patient triage. The traditional diagnostic techniques for the dengue virus are viral detection in cell culture, serological testing, and RNA amplification using reverse transcriptase PCR. This paper discusses the conventional laboratory methods used for the diagnosis of dengue during the acute and convalescent phase and highlights the advantages and limitations of these routine laboratory tests. Subsequently, the biosensor based assays developed using various transducers for the detection of dengue are also reviewed.
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Affiliation(s)
- Om Parkash
- Department of Medical Microbiology and Parasitology, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Rafidah Hanim Shueb
- Department of Medical Microbiology and Parasitology, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Cucunawangsih, Lugito NPH, Kurniawan A. Immunoglobulin G (IgG) to IgM ratio in secondary adult dengue infection using samples from early days of symptoms onset. BMC Infect Dis 2015; 15:276. [PMID: 26193930 PMCID: PMC4509644 DOI: 10.1186/s12879-015-1022-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Dengue virus (DENV) infection is an emerging arboviral infection in tropical and sub-tropical countries in South-East Asia, the Western Pacific and South and Central America. Secondary DENV infection is the most widely accepted risk factor for the development of severe forms. Methods to discriminate primary and secondary DENV infection may be of great prognostic value. ELISA based detection of specific antibodies (IgG and IgM) to the four DENV serotypes is valuable for detemination of primary or secondary infection. Several studies had been performed to discriminate primary and secondary DENV infection using the ratio of IgG and IgM at the various days of symptoms onset. The aim of this study is to determine the best cut-off point of IgG to IgM ratio is able to discriminating secondary from primary DENV infection in adult using samples from early days of symptoms onset. Methods This prospective cohort study on 48 adult patients with DENV infected patients on the period of August 2011–January 2012 in 5 out-patient settings health facilities in Tangerang district, Banten province, Indonesia with chief complaint of fever less than 3 days. Datas were collected on the day the patients attended health facilities, consisted of demographic, clinical, laboratory, and serological data. Serological data from 48 serum sample from adult patients were evaluated using Focus Diagnostics Dengue Virus IgM and IgG Capture DxSelect™ ELISA Kits to determine IgG, IgM index values and SD Bioline Dengue Duo™ Rapid Tests to determine NS1, IgG, and IgM result. Results According to NS1, IgG and IgM results, 36 patients were classified as secondary infection, 12 were primary Infection. The mean (SD) of IgG/IgM ratios for secondary and primary infection were 3.28 (0.54) and 0.18 (0.11) consecutively. The IgG/IgM ratio of ≥ 1.14 confirmed secondary infection with sensitivity of 80.56 %, specificity 91.67 %, accuracy level 83.33 %, and likely hood ratio of (LR) 9.67. Conclusion The IgG/IgM ratio of ≥ 1.14 as the best cut off point to determine secondary DENV infection in early days of symptoms onset.
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Affiliation(s)
- Cucunawangsih
- Microbiology Department, Faculty of Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia.
| | - Nata Pratama Hardjo Lugito
- Internal Medicine Department, Faculty of Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia.
| | - Andree Kurniawan
- Internal Medicine Department, Faculty of Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, 15811, Indonesia.
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Dayan G, Arredondo JL, Carrasquilla G, Deseda CC, Dietze R, Luz K, Costa MSN, Cunha RV, Rey LC, Morales J, Reynales H, Miranda M, Zambrano B, Rivas E, Garbes P, Noriega F. Prospective cohort study with active surveillance for fever in four dengue endemic countries in Latin America. Am J Trop Med Hyg 2015; 93:18-23. [PMID: 26013373 PMCID: PMC4497892 DOI: 10.4269/ajtmh.13-0663] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 10/11/2014] [Indexed: 11/07/2022] Open
Abstract
To prepare for a Phase III dengue vaccine efficacy trial, 20 investigational sites were selected for this observational study to identify dengue infections in a closed cohort (N = 3,000 children 9-16 years of age). Of 255 acute febrile episodes experienced by 235 children, 50 (21.3%) were considered serologically probable dengue, and 18 (7.7%) were considered virologically confirmed (i.e., dengue NS1 antigen positive) dengue cases. Considering the disease-free and at-risk period from study start to onset of symptoms, the overall incidence density of acute febrile episodes was 17.7 per 100 person-years of follow-up, ranging from 15.3 in Colombia to 22.0 in Puerto Rico. This study showed that all sites were capable of capturing and following up acute febrile episodes within a specific timeframe among the established cohort and to detect dengue cases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Enrique Rivas
- Clinical Research and Development, Sanofi Pasteur, Sao Paulo, Brazil; Instituto Nacional de Pediatria, Unidad de Apoyo a la Investigación Clínica, Mexico City, Mexico; Centro de Estudios de Investigación en Salud, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Caribbean Travel Medicine Clinic, San Juan, Puerto Rico; Nucleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil; Hospital Infantil Varela Santiago, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Hospital Universitário, Universidade Federal de Goiás, Goiania, Goias, Brazil; Hospital Universitário, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; Instituto de Biomedicina, Unidade de Pesquisas Clínicas, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Clinical Research Puerto Rico, Guayama, Puerto Rico; Centro de Atención e Investigación Médica, Bogotá, Colombia; Clinical Research and Development, Sanofi Pasteur, Bogotá, Colombia; Clinical Research and Development, Sanofi Pasteur, Montevideo, Uruguay; Clinical Research and Development, Sanofi Pasteur, Mexico City, Mexico; Clinical Research and Development, Sanofi Pasteur, Swiftwater, Pennsylvania
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De La Cruz Hernández SI, Reyes-del Valle J, Villegas-del Angel E, Ludert JE, del Angel RM. Dengue laboratory diagnosis: still some room for improvement. Future Virol 2015. [DOI: 10.2217/fvl.15.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dengue is the most important and widely distributed arthropod-borne viral disease affecting humans. The number of dengue virus infections has steadily grown and more than 100 countries survey dengue incidence every year. Due to the lack of an approved antiviral treatment or licensed preventative vaccine, accurate and opportune diagnosis is commended for efficient dengue epidemiological surveillance, to propose control measures in order to curtail outbreaks timely and treat patients satisfactorily. In this review, the basis, application and indications for different diagnostic tests are described, and their advantages and limitations considered. At the end of this piece, we speculate what the future may hold for the diagnosis of dengue infections.
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Affiliation(s)
- Sergio Isaac De La Cruz Hernández
- Department of Virology, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Mexico
- Departament of Infectomics & Molecular Pathogenesis, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), D.F., Mexico
| | | | | | - Juan E Ludert
- Departament of Infectomics & Molecular Pathogenesis, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), D.F., Mexico
| | - Rosa M del Angel
- Departament of Infectomics & Molecular Pathogenesis, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), D.F., Mexico
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Cleton NB, Godeke GJ, Reimerink J, Beersma MF, van Doorn HR, Franco L, Goeijenbier M, Jimenez-Clavero MA, Johnson BW, Niedrig M, Papa A, Sambri V, Tami A, Velasco-Salas ZI, Koopmans MPG, Reusken CBEM. Spot the difference-development of a syndrome based protein microarray for specific serological detection of multiple flavivirus infections in travelers. PLoS Negl Trop Dis 2015; 9:e0003580. [PMID: 25767876 PMCID: PMC4359159 DOI: 10.1371/journal.pntd.0003580] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/31/2015] [Indexed: 12/14/2022] Open
Abstract
Background The family Flaviviridae, genus Flavivirus, holds many of the world’s most prevalent arboviral diseases that are also considered the most important travel related arboviral infections. In most cases, flavivirus diagnosis in travelers is primarily based on serology as viremia is often low and typically has already been reduced to undetectable levels when symptoms set in and patients seek medical attention. Serological differentiation between flaviviruses and the false-positive results caused by vaccination and cross-reactivity among the different species, are problematic for surveillance and diagnostics of flaviviruses. Their partially overlapping geographic distribution and symptoms, combined with increase in travel, and preexisting antibodies due to flavivirus vaccinations, expand the need for rapid and reliable multiplex diagnostic tests to supplement currently used methods. Goal We describe the development of a multiplex serological protein microarray using recombinant NS1 proteins for detection of medically important viruses within the genus Flavivirus. Sera from clinical flavivirus patients were used for primary development of the protein microarray. Results Results show a high IgG and IgM sensitivity and specificity for individual NS1 antigens, and limited cross reactivity, even within serocomplexes. In addition, the serology based on this array allows for discrimination between infection and vaccination response for JEV vaccine, and no cross-reactivity with TBEV and YFV vaccine induced antibodies when testing for antibodies to other flaviviruses. Conclusion Based on these data, multiplex NS1-based protein microarray is a promising tool for surveillance and diagnosis of flaviviruses. The number of international travelers has increased dramatically in recent decades. This has contributed to the increase in infectious diseases in travelers which are not present in their countries of origin and so may cause a threat to the public health. Viruses transmitted by biting insects (vector-borne viruses) are an important group within these travel-related diseases. They are found across the world and can cause debilitating and life-threatening symptoms, like inflammation of the brain or excessive bleeding. Many of these diseases are difficult to distinguish from each other. They cause comparable symptoms and are genetically closely related. Testing for long lists of diseases is time consuming and expensive. Here we develop a novel testing tool that allows doctors and researchers to test for multiple viruses with just one test. The method, which uses a specific part of the virus that makes distinguishing between infections with these closely related viruses possible, requires only one drop of blood. This allows us to test for multiple viruses simultaneously with the same amount of blood previously used to test for only one virus, while distinguishing between genetically closely related viruses.
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Affiliation(s)
- Natalie B. Cleton
- Erasmus Medical Centre, Viroscience Department, Rotterdam, The Netherlands
- National Institute for Public Health and Environment, Center for Infectious Diseases Research and Screening, Bilthoven, The Netherlands
- * E-mail:
| | - Gert-Jan Godeke
- National Institute for Public Health and Environment, Center for Infectious Diseases Research and Screening, Bilthoven, The Netherlands
| | - Johan Reimerink
- National Institute for Public Health and Environment, Center for Infectious Diseases Research and Screening, Bilthoven, The Netherlands
| | - Mathias F. Beersma
- Erasmus Medical Centre, Viroscience Department, Rotterdam, The Netherlands
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leticia Franco
- Arbovirus and Imported Viral Diseases Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Marco Goeijenbier
- Erasmus Medical Centre, Viroscience Department, Rotterdam, The Netherlands
| | - Miguel A. Jimenez-Clavero
- Centro de Investigación en Sanidad Animal (CISA), Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Ctra Algete- El Casar, Valdeolmos, Madrid, Spain
| | - Barbara W. Johnson
- Diagnostic & Reference Laboratory, Arboviral Diseases Branch, Division of Vector-Borne Diseases (DVBD), Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado, United States of America
| | - Matthias Niedrig
- Centre for Biological Threats and Special Pathogens, Robert Koch-Institut, Berlin, Germany
| | - Anna Papa
- National Reference Centre for Arboviruses and Hemorrhagic Fever Viruses, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vittorio Sambri
- DIMES—University of Bologna, Unit of Microbiology, Bologna, Italy
- The Greater Romagna Area Hub Laboratory, Pievesestina, Italy
| | - Adriana Tami
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Departamento de Parasitología, Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela
| | - Zoraida I. Velasco-Salas
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Departamento de Biología, Facultad Experimental de Ciencia y Tecnología, Universidad de Carabobo, Valencia, Venezuela
| | - Marion P. G. Koopmans
- Erasmus Medical Centre, Viroscience Department, Rotterdam, The Netherlands
- National Institute for Public Health and Environment, Center for Infectious Diseases Research and Screening, Bilthoven, The Netherlands
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Platelet activating factor contributes to vascular leak in acute dengue infection. PLoS Negl Trop Dis 2015; 9:e0003459. [PMID: 25646838 PMCID: PMC4315531 DOI: 10.1371/journal.pntd.0003459] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/05/2014] [Indexed: 01/10/2023] Open
Abstract
Background Although plasma leakage is the hallmark of severe dengue
infections, the factors that cause increased vascular permeability have not been identified. As platelet activating factor (PAF) is associated with an increase in vascular permeability in other diseases, we set out to investigate its role in acute dengue infection. Materials and Methods PAF levels were initially assessed in 25 patients with acute dengue infection to determine if they were increased in acute dengue. For investigation of the kinetics of PAF, serial PAF values were assessed in 36 patients. The effect of dengue serum on tight junction protein ZO-1 was determined by using human endothelial cell lines (HUVECs). The effect of dengue serum on and trans-endothelial resistance (TEER) was also measured on HUVECs. Results PAF levels were significantly higher in patients with acute dengue (n = 25; p = 0.001) when compared to healthy individuals (n = 12). In further investigation of the kinetics of PAF in serial blood samples of patients (n = 36), PAF levels rose just before the onset of the critical phase. PAF levels were significantly higher in patients with evidence of vascular leak throughout the course of the illness when compared to those with milder disease. Serum from patients with dengue significantly down-regulated expression of tight junction protein, ZO-1 (p = 0.004), HUVECs. This was significantly inhibited (p = 0.004) by use of a PAF receptor (PAFR) blocker. Serum from dengue patients also significantly reduced TEER and this reduction was also significantly (p = 0.02) inhibited by prior incubation with the PAFR blocker. Conclusion Our results suggest the PAF is likely to be playing a significant role in inducing vascular leak in acute dengue infection which offers a potential target for therapeutic intervention. Although plasma leakage is the hallmark of severe dengue
infections, the factors that cause increased vascular permeability have not been identified. As platelet activating factor (PAF) is associated with an increase in vascular permeability in other diseases, we set out to investigate its role in acute dengue infection. In this study, we found that PAF was significantly increased in patients with DHF, and the PAF levels rose just before the onset of the critical phase of dengue, during which vascular leak is thought to occur. PAF in serum of dengue patients was associated with reduced expression of tight junction proteins (ZO-1) and reduction in trans-endothelial resistance (TEER) of human endothelial cells. Use of PAFR blockers significantly reduced the down regulation of ZO-1 by serum of dengue patients and also the reduction of TEER, suggesting that PAF plays a significant role in inducing vascular leak in acute dengue infections.
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Mohamad Zamberi Z, Zakaria Z, Abdul Aziz AT, Heng BSL, Zaid M, Chong CLK, Noor FM, Abu Bakar S, Boon Peng H. The high-affinity human IgG receptor Fc gamma receptor I (FcγRI) is not associated with vascular leakage of dengue. J Negat Results Biomed 2015; 14:1. [PMID: 25566870 PMCID: PMC4300171 DOI: 10.1186/s12952-014-0020-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/17/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dengue is a major public health problem in many tropical and sub-tropical countries. Vascular leakage and shock are identified as the major causes of deaths in patients with severe dengue. Studies have suggested the potential role of Fc gamma receptors I (FcγRI) in the pathogenesis of dengue. We hypothesized that the circulating level of Fcγ receptor I could potentially be used as an indicator in assisting early diagnosis of severe dengue. RESULTS A selected cohort of 66 dengue patients including 42 dengue with signs of vascular leakage, and 24 dengue without signs of vascular leakage were identified and were afterwards referred to as 'cases' and 'controls' respectively. Thirty seven normal healthy controls were also recruited in this study. The circulating level of FcγRI was quantified from the serum using enzyme-link immunosorbent assay (ELISA). The levels of FcγRI in both groups of patients with and without vascular leakage were found to be significantly higher than the normal healthy controls (P < 0.001). However, there was no significant difference found between patients with vascular leakage and those without vascular leakage (p = 0.777). CONCLUSION We suggest that FcγRI is not associated with the vascular leakage in dengue. However, further studies are necessary to delineate the role of FcγRI in antibody-dependent enhancement (ADE) mechanism.
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Affiliation(s)
- Zaiharina Mohamad Zamberi
- Institute of Molecular Medical Biotechnology (IMMB), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Zuraihan Zakaria
- Institute of Molecular Medical Biotechnology (IMMB), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Abu Thalhah Abdul Aziz
- Institute of Molecular Medical Biotechnology (IMMB), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Benedict Sim Lim Heng
- Hospital Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor Darul Ehsan, Malaysia.
| | - Masliza Zaid
- Hospital Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor Darul Ehsan, Malaysia.
| | | | - Fadzilah Mohd Noor
- Microbiology Unit, Centre for Pathology Diagnostic and Research Laboratories (CPDRL), Level 1, Clinical Training Centre (CTC), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia. .,Drug and Discovery Research Core, Universiti Teknologi MARA, Shah Alam, 40450, Shah Alam, Selangor, Malaysia.
| | - Sazaly Abu Bakar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Tropical Infectious Disease Research and Education Centre, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Hoh Boon Peng
- Institute of Molecular Medical Biotechnology (IMMB), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000, Sungai Buloh, Selangor, Malaysia. .,Drug and Discovery Research Core, Universiti Teknologi MARA, Shah Alam, 40450, Shah Alam, Selangor, Malaysia.
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Gomes L, Fernando S, Fernando RH, Wickramasinghe N, Shyamali NLA, Ogg GS, Malavige GN. Sphingosine 1-phosphate in acute dengue infection. PLoS One 2014; 9:e113394. [PMID: 25409037 PMCID: PMC4237441 DOI: 10.1371/journal.pone.0113394] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/23/2014] [Indexed: 12/26/2022] Open
Abstract
Background Vascular leak is the hallmark of severe dengue infections and leads to complications such as shock and multi-organ failure. Although many mediators have been implicated in the vascular leak in dengue, the role of sphingosine 1-phosphate (S1P) has not been investigated. Metholodology/Principal findings As S1P has been shown to be important in barrier integrity, we assessed the S1P levels in 28 patients with acute dengue and 12 healthy individuals. The S1P levels were significantly lower in patients with acute dengue (p = 0.002) and the levels in patients with grade IV dengue haemorrhagic fever (DHF) were significantly lower than those with dengue fever (p = 0.005). We then investigated the kinetics of S1P levels throughout the course of the illness in another 32 patients in serum samples obtained twice a day. We found that S1P levels were low throughout the course of illness and S1P levels were <0.5 µM in 12/23 patients with DHF when compared to 1/9 with DF. Conclusions/Significance As S1P has shown to be important in the endothelial barrier integrity and increases transendothelial resistance, low levels of S1P in acute dengue infection are likely to contribute to increased vascular permeability.
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Affiliation(s)
- Laksiri Gomes
- Centre for Dengue Research, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura, Gangodawila, Sri Lanka
| | - Samitha Fernando
- Centre for Dengue Research, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura, Gangodawila, Sri Lanka
| | - Randika Heshan Fernando
- Centre for Dengue Research, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura, Gangodawila, Sri Lanka
| | - Nilanka Wickramasinghe
- Centre for Dengue Research, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura, Gangodawila, Sri Lanka
| | - Narangoda Liyanage Ajantha Shyamali
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford NIHR Biomedical Research Centre and University of Oxford, Oxford, United Kingdom
| | - Graham S Ogg
- Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
| | - Gathsaurie Neelika Malavige
- Centre for Dengue Research, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura, Gangodawila, Sri Lanka; Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
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Hermann LL, Thaisomboonsuk B, Poolpanichupatam Y, Jarman RG, Kalayanarooj S, Nisalak A, Yoon IK, Fernandez S. Evaluation of a dengue NS1 antigen detection assay sensitivity and specificity for the diagnosis of acute dengue virus infection. PLoS Negl Trop Dis 2014; 8:e3193. [PMID: 25275493 PMCID: PMC4183466 DOI: 10.1371/journal.pntd.0003193] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/17/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Currently, no dengue NS1 detection kit has regulatory approval for the diagnosis of acute dengue fever. Here we report the sensitivity and specificity of the InBios DEN Detect NS1 ELISA using a panel of well characterized human acute fever serum specimens. METHODOLOGY/PRINCIPAL FINDINGS The InBios DENV Detect NS1 ELISA was tested using a panel composed of 334 serum specimens collected from acute febrile patients seeking care in a Bangkok hospital in 2010 and 2011. Of these patients, 314 were found to have acute dengue by either RT-PCR and/or anti-dengue IgM/IgG ELISA. Alongside the InBios NS1 ELISA kit, we compared the performance characteristics of the BioRad Platelia NS1 antigen kit. The InBios NS1 ELISA Ag kit had a higher overall sensitivity (86% vs 72.8%) but equal specificity (100%) compared to the BioRad Platelia kit. The serological status of the patient significantly influenced the outcome. In primary infections, the InBios NS1 kit demonstrated a higher sensitivity (98.8%) than in secondary infections (83.5%). We found significant variation in the sensitivity of the InBios NS1 ELISA kit depending on the serotype of the dengue virus and also found decreasing sensitivity the longer after the onset of illness, showing 100% sensitivity early during illness, but dropping below 50% by Day 7. CONCLUSION/SIGNIFICANCE The InBios NS1 ELISA kit demonstrated high accuracy when compared to the initial clinical diagnosis with greater than 85% agreement when patients were clinically diagnosed with dengue illness. Results presented here suggest the accurate detection of circulating dengue NS1 by the InBios DENV Detect NS1 ELISA can provide clinicians with a useful tool for diagnosis of early dengue infections.
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Affiliation(s)
- Laura L. Hermann
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Richard G. Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Washington D.C., United States of America
| | | | - Ananda Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- * E-mail:
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Noecker CA, Amaya-Larios IY, Galeana-Hernández M, Ramos-Castañeda J, Martínez-Vega RA. Contrasting associations of polymorphisms in FcγRIIa and DC-SIGN with the clinical presentation of dengue infection in a Mexican population. Acta Trop 2014; 138:15-22. [PMID: 24911936 DOI: 10.1016/j.actatropica.2014.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/14/2014] [Accepted: 05/30/2014] [Indexed: 02/02/2023]
Abstract
Dengue virus (DENV) causes a spectrum of illness from asymptomatic infection, to a mild febrile illness, to occasional more severe complications including hemorrhage and shock. Dengue is endemic in the state of Morelos, Mexico. Two single nucleotide polymorphisms (SNPs), rs1801274 of FcγRIIa and rs4804803 of DC-SIGN, have been associated with protection from or susceptibility to severe dengue infection. Both of these polymorphisms are located in genes for receptors with important roles in dengue pathogenesis, and their relationship with the clinical presentation of dengue infection in Mexican populations is unknown. In this study, real-time PCR was used to characterize the distribution of rs1801274 and rs4804803 in subjects with asymptomatic dengue infection (n=145), uncomplicated dengue (n=67), and severe dengue (n=36) in Morelos. In contrast with previous studies, the histidine (A) variant of rs1801274 was associated with more mild infection: carrying the histidine allele (either homozygous or heterozygous) was associated with protection from symptomatic infection compared with asymptomatic (OR 0.51, p=0.038). Histidine homozygotes were also less likely to present severe dengue (OR 0.34, p=0.05). Logistic regression models confirm this association (OR 0.48, p=0.04) and also indicate that the G allele of rs4804803 is associated with symptomatic dengue (OR 2.3, p=0.08), after accounting for other biological factors including history of infection. This variant was rare in this study population, with a frequency of 5.4%. These findings reflect the complexity of influences on the development of severe dengue infection. The inclusion of asymptomatic infections and adjusted case definitions likely do not explain the entire disparity with previous findings. Interactions with other polymorphisms may explain why the association of rs1801274 is reversed in this population compared to others. This study demonstrates the importance of genetic association studies in multiple genetically distinct populations.
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Clinical implications and treatment of dengue. ASIAN PAC J TROP MED 2014; 7:169-78. [PMID: 24507635 DOI: 10.1016/s1995-7645(14)60016-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/15/2013] [Accepted: 03/15/2014] [Indexed: 11/21/2022] Open
Abstract
Dengue is a common pathogenic disease often proving fatal, more commonly affecting the tropics. Aedes mosquito is the vector for this disease, and outbreaks of dengue often cause mass damage to life. The current review is an effort to present an insight into the causes, etiology, symptoms, transmission, diagnosis, major organs affected, mitigation and line of treatment of this disease with special emphasis on drugs of natural origin. The disease has a potential to spread as an endemic, often claiming several lives and thus requires concerted efforts to work out better treatment options. Traditional medicine offers an alternative solution and could be explored as a safer treatment option. Development of a successful vaccine and immunization technique largely remains a challenge and a better antiviral approach needs to be worked out to complement the supportive therapy. No single synthetic molecule has found to be wholly effective enough to offer curative control and the line of treatment mostly utilizes a combination of fluid replacement and antipyretics-analgesics like molecules to provide symptomatic relief.
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NS1 antigen detecting assays for diagnosing acute dengue infection in people living in or returning from endemic countries. Hippokratia 2014. [DOI: 10.1002/14651858.cd011155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Halsey ES, Williams M, Laguna-Torres VA, Vilcarromero S, Ocaña V, Kochel TJ, Marks MA. Occurrence and correlates of symptom persistence following acute dengue fever in Peru. Am J Trop Med Hyg 2014; 90:449-56. [PMID: 24470564 DOI: 10.4269/ajtmh.13-0544] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue virus (DENV) infection causes an acute febrile illness generally considered to result in either complete recovery or death. Some reviews describe persistent symptoms after the febrile phase, although empirical data supporting this phenomenon is scarce. We evaluated symptom persistence in acute febrile DENV-infected and DENV-negative (controls) individuals from Peru. Self-reported solicited symptoms were evaluated at an acute and a follow-up visit, occurring 10-60 days after symptom onset. Rate of persistence of at least one symptom was 7.7% and 10.5% for DENV infected and control subjects, respectively (P < 0.01). The DENV-infected individuals had lower rates of persistent respiratory symptoms, gastrointestinal symptoms, headache, and fatigue, but higher rates of persistent rash compared with controls. Older age and female gender were positively associated with symptom persistence. As dengue cases continue to increase annually, even a relatively low frequency of persistent symptoms may represent a considerable worldwide morbidity burden.
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Affiliation(s)
- Eric S Halsey
- Virology Department, United States Naval Medical Research Unit No. 6, Lima and Iquitos, Peru; Dirección Regional de Salud de Piura, Ministerio de Salud, Piura, Peru; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Evaluation of the SD BIOLINE Dengue Duo rapid test in the course of acute and convalescent dengue infections in a Mexican endemic region. Diagn Microbiol Infect Dis 2014; 78:368-72. [PMID: 24480246 DOI: 10.1016/j.diagmicrobio.2013.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 11/20/2022]
Abstract
In this study, we evaluated the performance of a rapid test, the SD BIOLINE Dengue Duo (SD BDD) kit, with a panel of serum samples from 310 Mexican patients with diagnosis of dengue infection previously confirmed by reference enzyme-linked immunosorbent assay tests. Eighty-seven negative samples from other febrile illnesses were included as controls. The SD BDD showed an overall sensitivity of 90.65% and specificity of 89.66%. No statistically significant differences were found in the sensitivity of the SD BDD kit compared between primary or secondary infections (87.05% versus 93.57%, respectively, P = 0.0761) and dengue fever or dengue hemorrhagic fever cases (90.77% versus 89.74%, respectively, P = 0.7716). However, a higher sensitivity in the acute phase of dengue infection was found compared with the convalescent phase (93.03% versus 81.82%, respectively, P = 0.0089). These results indicate that the SD BDD kit is a useful tool to diagnose dengue infections, both in primary or secondary infections and mainly during the acute phase.
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Chagan-Yasutan H, Ndhlovu LC, Lacuesta TL, Kubo T, Leano PSA, Niki T, Oguma S, Morita K, Chew GM, Barbour JD, Telan EFO, Hirashima M, Hattori T, Dimaano EM. Galectin-9 plasma levels reflect adverse hematological and immunological features in acute dengue virus infection. J Clin Virol 2013; 58:635-40. [PMID: 24239423 DOI: 10.1016/j.jcv.2013.10.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/29/2013] [Accepted: 10/18/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Dengue virus (DENV) infection remains a major public health burden worldwide. Soluble mediators may play a critical role in the pathogenesis of acute DENV infection. Galectin-9 (Gal-9) is a soluble β-galactoside-binding lectin, with multiple immunoregulatory and inflammatory properties. OBJECTIVE To investigate plasma Gal-9 levels as a biomarker for DENV infection. STUDY DESIGN We enrolled 65 DENV infected patients during the 2010 epidemic in the Philippines and measured their plasma Gal-9 and cytokine/chemokine levels, DENV genotypes, and copy number during the critical and recovery phases of illness. RESULTS During the critical phase, Gal-9 levels were significantly higher in DENV infected patients compared to healthy or those with non-dengue febrile illness. The highest Gal-9 levels were observed in dengue hemorrhagic fever (DHF) patients (DHF: 2464 pg/ml; dengue fever patients (DF): 1407 pg/ml; non-dengue febrile illness: 616 pg/ml; healthy: 196 pg/ml). In the recovery phase, Gal-9 levels significantly declined from peak levels in DF and DHF patients. Gal-9 levels tracked viral load, and were associated with multiple cytokines and chemokines (IL-1α, IL-8, IP-10, and VEGF), including monocyte frequencies and hematologic variables of coagulation. Further discriminant analyses showed that eotaxin, Gal-9, IFN-α2, and MCP-1 could detect 92% of DHF and 79.3% of DF, specifically (P<0.01). CONCLUSION Gal-9 appears to track DENV inflammatory responses, and therefore, it could serve as an important novel biomarker of acute DENV infection and disease severity.
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Affiliation(s)
- Haorile Chagan-Yasutan
- Laboratory of Disaster-Related Infectious Disease, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan; Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Duber HC, Kelly SM. Febrile Illness in a Young Traveler: Dengue Fever and its Complications. J Emerg Med 2013; 45:526-9. [DOI: 10.1016/j.jemermed.2013.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/02/2012] [Accepted: 03/15/2013] [Indexed: 10/26/2022]
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Malavige GN, Gomes L, Alles L, Chang T, Salimi M, Fernando S, Nanayakkara KD, Jayaratne S, Ogg GS. Serum IL-10 as a marker of severe dengue infection. BMC Infect Dis 2013; 13:341. [PMID: 23883139 PMCID: PMC3733887 DOI: 10.1186/1471-2334-13-341] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/10/2013] [Indexed: 12/02/2022] Open
Abstract
Background Several studies have shown that serum IL-10, IFNγ and MIF are elevated in patients in severe dengue (SD) and could be used as potential biomarkers. We proceeded to determine if these cytokines could be used as biomarkers in a large cohort of adult dengue patients with varying severity of dengue infection. Methods Serum IL-10 levels were determined in 259 of whom 40 had severe dengue infection. Serum IFNγ and IFNα levels were done in 78 and MIF levels were done in 65 patients with acute dengue infection. Clinical features and laboratory investigations were undertaken during the febrile and critical phase. Results We found that serum IL-10 levels were significantly higher (p = 0.001) in patients with SD, when compared to those with non SD. Serum IL-10 levels significantly and inversely correlated with white cell counts (R = −0.23, p = 0.0002) and lymphocyte counts (R = −0.29, p < 0.0001) but significantly and positively correlated with aspartate tranaminase levels (R = 0.16, p = 0.01) and alanine transaminase levels (R = 0.22, p = 0.007). However, IL-10 levels did not have a good predictive value in discriminating those who were likely to develop SD (AUC = 0.66). Serum IFNγ levels were also significantly higher (p = 0.04) in patients with SD when compared to non SD. There was no difference (p = 0.34) in serum IFNα levels and serum MIF levels (p = 0.15) in patients with SD and non SD. Conclusion Although serum IL-10 was significantly elevated in patients with SD it had a poor discriminatory value in identifying those with SD and non SD and therefore, is unsuitable to be used as a robust biomarker in this cohort.
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Leder K, Mutsch M, Schlagenhauf P, Luxemburger C, Torresi J. Seroepidemiology of dengue in travellers: a paired sera analysis. Travel Med Infect Dis 2013; 11:210-3. [PMID: 23890678 DOI: 10.1016/j.tmaid.2013.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/31/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dengue is a frequent cause of fever in travellers. The true extent is unknown as many infections are asymptomatic or undiagnosed. METHODS We used paired sera, with pre- and post-travel specimens from Swiss travellers to tropical destinations, to evaluate the seroepidemiology of travel-related dengue. Post-travel specimens were tested for the presence of IgG and IgM antibodies to dengue antigen serotypes (1, 2, 3 and 4) using an indirect enzyme-linked immunosorbent assay (ELISA). All post-travel sera that screened as positive for dengue IgG or IgM antibodies were re-tested with the corresponding pre-travel sera as paired assays in order to detect seroconversion. RESULTS There were 285 travellers with specimens available for analysis. Two hundred and fifty seven of the 285 individuals (90.2%) had negative dengue serology post-travel. Of the remaining 28 cases, 25 were dengue IgG positive and 3 had equivocal results. This corresponds to IgG seropositivity in 8.9%. Eighteen of these 25 individuals had a pre-travel specimen available for testing, of which 15 were positive for IgG consistent with possible past exposure. Three of the 18 had negative serology pre-travel, indicating possible recent infection. This corresponds to an attack rate of possible dengue of 1.1% and an incidence rate of 6.7 per 1000 person-months (95% CI 0-60.0). Two of these three individuals had received yellow fever vaccine for their trip, raising the potential of cross-reactivity. The confirmed dengue attack rate therefore was 0.23% with a corresponding incidence rate of 2.2 per 1000 person-months (95% CI-0-33.1). CONCLUSIONS Seroepidemiology provides additional evidence of an appreciable risk of acute dengue infection among travellers to tropical destinations.
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Affiliation(s)
- Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.
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