Volume 91, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



During the last decade Martinique experienced four dengue epidemics, each characterized by the predominance of 1 or 2 serotypes. In this retrospective database analysis, we investigated the relationship between dengue serotype and disease severity. Data on dengue were collected from 715 patients (male/female ratio 0.87), 14 to 91 years of age (median 35 years) examined in the adult emergency department between 2005 and 2010. In this series, DENV-4 infections more frequently had a milder clinical presentation. The DENV-2 infections were most often secondary infections admitted at the critical phase of dengue illness with signs of plasma leakage. The DENV-1 infections were disabling, particularly in females, and most often led to disease of intermediate severity, without overt plasma leakage. These data were consistent with there being differences in virulence between serotypes, regardless of the host's immune status. However, secondary DENV-2 infections showed an increased risk of plasma leakage.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Quénel P, Rosine J, Cassadou S, Ardillon V, Blateau A, Mattheus S, Chappert JL, Flamand C, Carvalho L, Cardoso T, Chaud P, Dussart P, Ledrans M, , 2011. Épidémiologie de la dengue dans les Départements français d'Amérique. Bulletin épidémiologique hebdomadaire, 20 Septembre 2011, 358362. Available at: http://www.invs.sante.fr/Publications-et-outils/BEH-Bulletin-epidemiologique-hebdomadaire/Archives/2011/BEH-n-33-34-2011. Accessed September 20, 2011.
  2. Simmons CP, Farrar JJ, Nguyen vV, Wills B, , 2012. Dengue. N Engl J Med 366: 14231432.[Crossref] [Google Scholar]
  3. Sabchareon A, Wallace D, Sirivichayakul C, Limkittikul K, Chanthavanich P, Suvannadabba S, Jiwariyavej V, Dulyachai W, Pengsaa K, Wartel TA, Moureau A, Saville M, Bouckenooghe A, Viviani S, Tornieporth NG, Lang J, , 2012. Protective efficacy of the recombinant, live-attenuated, CYD tetravalent dengue vaccine in Thai schoolchildren: a randomized, controlled phase 2b trial. Lancet 380: 15591567.[Crossref] [Google Scholar]
  4. Villar LA, Rivera-Medina DM, Arredondo-García JL, Boaz M, Starr-Spires L, Thakur M, Zambrano B, Miranda MC, Rivas E, Dayan GH, , 2013. Safety and immunogenicity of a recombinant tetravalent dengue vaccine in 9–16 years old: a randomized, controlled, Phase II trial in Latin America. Pediatr Infect Dis J 32: 11021109.[Crossref] [Google Scholar]
  5. Thomas L, Moravie V, Besnier F, Valentino R, Kaidomar S, Villain Coquet L, Najioullah F, Lengellé F, Césaire R, Cabié A, Working Group on Dengue; , 2012. Clinical presentation of dengue among patients admitted to the adult emergency department of a tertiary care hospital in Martinique: implications for triage, management, and reporting. Ann Emerg Med 59: 4250.[Crossref] [Google Scholar]
  6. Najioullah F, Combet E, Paturel L, Martial J, Koulmann L, Thomas L, Hatchuel Y, Cabié A, Cesaire R, , 2011. Prospective evaluation of nonstructural 1 enzyme-linked immunosorbent assay and rapid immunochromatographic tests to detect dengue virus in patients with acute febrile illness. Diagn Microbiol Infect Dis 69: 172178.[Crossref] [Google Scholar]
  7. World Health Organization, 1997. Dengue Hemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Second edition. Geneva: World Health Organization. Available at: http://www.who.int/csr/resources/publications/dengue/Denguepublication/en. Accessed January 20, 2010. [Google Scholar]
  8. World Health Organization, 2009. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. WHO/HTM/NTD/DEN/2009.1. Available at: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf. Accessed May 17, 2010. [Google Scholar]
  9. Srikiatkhachorn A, Rothman AL, Gibbons RV, Sittisombut N, Malasit P, Ennis FA, Mannitya S, Kalayanarooj S, , 2011. Dengue–how best to classify it. Clin Infect Dis 53: 563567.[Crossref] [Google Scholar]
  10. Halstead SB, , 2013. Dengue: the syndromic basis to pathogenesis research. Inutility of the 2009 WHO case definition. Am J Trop Med Hyg 88: 212215.[Crossref] [Google Scholar]
  11. Farrar JJ, Hien TT, Horstick O, Hung NT, Jaenisch T, Junghanns T, Kroeger A, Laksono IS, Lum L, Martinez E, Simmons CP, Tami A, Tomashek KM, Wills BA, , 2013. Dogma in classifying dengue disease. Am J Trop Med Hyg 89: 198201.[Crossref] [Google Scholar]
  12. Murgue B, Deparis X, Chungue E, Cassar O, Roche C, , 1999. Dengue: an evaluation of dengue severity in French Polynesia based on an analysis of 403 laboratory-confirmed cases. Trop Med Int Health 4: 765773.[Crossref] [Google Scholar]
  13. Balmaseda A, Hammond SN, Pérez L, Tellez Y, Saborío SI, Mercado JC, Cuadra R, Rocha J, Pérez MA, Silva S, Rocha C, Harris E, , 2006. Serotype-specific differences in clinical manifestations of dengue. Am J Trop Med Hyg 74: 449456. [Google Scholar]
  14. Tsai JJ, Chan KS, Chang JS, Chang K, Lin CC, Huang JH, Lin WR, Chen TC, Hsieh HC, Lin SH, Lin JC, Lu PL, Chen YH, Lin CY, , 2009. Effect of serotypes on clinical manifestations of dengue fever in adults. J Microbiol Immunol Infect 42: 471478. [Google Scholar]
  15. Fried JR, Gibbons RV, Kalayanarooj S, Thomas SJ, Srikiatkhachorn A, Yoon IK, Jarman RG, Green S, Rothman AL, Cummings DA, , 2010. Serotype-specific differences in the risk of dengue hemorrhagic fever: an analysis of data collected in Bangkok, Thailand from 1994 to 2006. PLoS Negl Trop Dis 4: e617.[Crossref] [Google Scholar]
  16. Halsey ES, Marks MA, Gotuzzo E, Fiestas V, Suarez L, Vargas J, Aguayo N, Madrid C, Vimos C, Kochel TJ, Laguna-Torres VA, , 2012. Correlation of serotype-specific dengue virus infection with clinical manifestations. PLoS Negl Trop Dis 6: e1638.[Crossref] [Google Scholar]
  17. St John AL, Abraham SN, Gubler DJ, , 2013. Barriers to preclinical investigations of anti-dengue immunity and dengue pathogenesis. Nat Rev Microbiol 11: 420426.[Crossref] [Google Scholar]
  18. Burke DS, Nisalak A, Johnson DE, Scott RM, , 1988. A prospective study of dengue infections in Bangkok. Am J Trop Med Hyg 38: 172180. [Google Scholar]
  19. Endy TP, Nisalak A, Chunsuttitwat S, Vaughn DW, Green S, Ennis FA, Rothman AL, Libraty DH, , 2004. Relationship of preexisting dengue virus (DV) neutralizing antibody levels to viremia and severity of disease in a prospective cohort study of DV infection in Thailand. J Infect Dis 189: 9901000.[Crossref] [Google Scholar]
  20. Rodriguez-Barraquer I, Mier-Y-Teran-Romero L, Burke DS, Cummings DA, , 2013. Challenges in the interpretation of dengue vaccine trial results. PLoS Negl Trop Dis 7: e2126.[Crossref] [Google Scholar]
  21. OhAinle M, Balmaseda A, Macalalad AR, Tellez Y, Zody MC, Saborío S, Nuñez A, Lennon NJ, Birren BW, Gordon A, Henn MR, Harris E, , 2011. Dynamics of dengue disease severity determined by the interplay between viral genetics and serotype-specific immunity. Sci Transl Med 3: 114128.[Crossref] [Google Scholar]
  22. Nisalak A, Endy TP, Nimmannitya S, Kalayanarooj S, Thisayakorn U, Scott RM, Burke DS, Hoke CH, Innis BL, Vaughn DW, , 2003. Serotype-specific dengue virus circulation and dengue disease in Bangkok, Thailand from 1973 to 1999. Am J Trop Med Hyg 68: 191202. [Google Scholar]
  23. Halstead SB, Streit TG, Lafontant JG, Putvatana R, Russell K, Sun W, Kanesa-Thasan N, Hayes CG, Watts DM, , 2001. Haiti: absence of dengue hemorrhagic fever despite hyperendemic dengue virus transmission. Am J Trop Med Hyg 65: 180183. [Google Scholar]
  24. Schmidt WP, Suzuki M, Thiem VD, White RG, Tsuzuki A, Yoshida LM, Yanai H, Haque U, Tho le H, Anh DD, Ariyoshi K, , 2011. Population density, water supply, and the risk of dengue fever in Vietnam: cohort study and spatial analysis. PLoS Med 8: e1001082.[Crossref] [Google Scholar]
  25. Descloux E, Mangeas M, Menkes CE, Lengaigne M, Leroy A, Tehei T, Guillaumot L, Teurlai M, Gourinat AC, Benzler J, Pfannstiel A, Grangeon JP, Degallier N, De Lamballerie X, , 2012. Climate-based models for understanding and forecasting dengue epidemics. PLoS Negl Trop Dis 6: e1470.[Crossref] [Google Scholar]
  26. Loroño-Pino MA, Farfán-Ale JA, Zapata-Peraza AL, Rosado-Paredes EP, Flores-Flores LF, García-Rejón JE, Díaz FJ, Blitvich BJ, Andrade-Narváez M, Jiménez-Ríos E, Blair CD, Olson KE, Black W, 4th Beaty BJ, , 2004. Introduction of the American/Asian genotype of dengue 2 virus into the Yucatan State of Mexico. Am J Trop Med Hyg 71: 485492. [Google Scholar]
  27. Huy NT, Van Giang T, Thuy DH, Kikuchi M, Hien TT, Zamora J, Hirayama K, , 2013. Factors associated with dengue shock syndrome: a systematic review and meta-analysis. PLoS Negl Trop Dis 7: e2412.[Crossref] [Google Scholar]
  28. Rigau-Pérez JG, Laufer MK, , 2006. Dengue-related deaths in Puerto Rico, 1992–1996: diagnosis and clinical alarm signals. Clin Infect Dis 42: 12411246.[Crossref] [Google Scholar]
  29. Dussart P, Lavergne A, Lagathu G, Lacoste V, Martial J, Morvan J, Césaire R, , 2006. Reemergence of dengue virus type 4, French Antilles and French Guiana, 2004–2005. Emerg Infect Dis 12: 17481751.[Crossref] [Google Scholar]

Data & Media loading...


  • Received : 15 Oct 2013
  • Accepted : 19 Jan 2014
  • Published online : 02 Jul 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error