SEROTYPE-SPECIFIC DIFFERENCES IN CLINICAL MANIFESTATIONS OF DENGUE

ANGEL BALMASEDA Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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SAMANTHA N. HAMMOND Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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LEONEL PÉREZ Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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YOLANDA TELLEZ Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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SAIRA INDIRA SABORÍO Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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JUAN CARLOS MERCADO Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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RICARDO CUADRA Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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JULIO ROCHA Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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MARIA ANGELES PÉREZ Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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SHEYLA SILVA Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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CRISANTA ROCHA Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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EVA HARRIS Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California; Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua; Infectious Diseases Unit, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua

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Dengue, the most prevalent arthropod-borne viral disease of humans, is caused by four serotypes of dengue virus (DENV 1–4). Although all four DENV serotypes cause a range of illness, defining precisely which clinical characteristics are associated with the distinct serotypes has been elusive. A cross-sectional study was conducted on 984 and 313 hospitalized children with confirmed DENV infections during two time periods, respectively, in the same hospitals in Nicaragua: a 3-year period (1999–2001) when DENV-2 accounted for 96% of the viruses identified, and the 2003 dengue season when DENV-1 predominated (87% of identified serotypes). When the two periods were compared, more shock (OR 1.91, 95% CI 1.35–2.71) and internal hemorrhage (OR 2.05, CI 1.16–3.78) were observed in the period when DENV-2 predominated, whereas increased vascular permeability was associated to a greater degree with the DENV-1 period (OR 2.36, CI 1.80–3.09). Compared with the DENV-2 period, the DENV-1 season was associated with more hospitalized primary dengue cases (OR 3.86, CI 2.72–5.48) and more primary DENV infections with severe manifestations (OR 2.93, CI 2.00–4.28). These findings provide new data to characterize the pathogenic potential of distinct DENV serotypes in human populations.

Author Notes

Reprint requests: Eva Harris, Division of Infectious Diseases, School of Public Health, 140 Warren Hall, University of California, Berkeley, CA 94720-7360, Telephone: 510-642-4845, Fax: 510-642-6350, E-mail: eharris@berkeley.edu.
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