Analysis of Clinical and Laboratory Alterations Related to Dengue Case Severity: Comparison between Serotypes 2 and 4 in Brazil

Nieli Rodrigues da Costa Faria Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Victor Edgar Fiestas Solorzano Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;

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Luiz José de Souza Flavivirus Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil

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Rita Maria Ribeiro Nogueira Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Fernanda de Bruycker-Nogueira Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Thaís Chouin-Carneiro Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Jaqueline Bastos Santos Simões Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Monique da Rocha Queiroz Lima Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Luzia Maria de Oliveira Pinto Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;

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Claire Fernandes Kubelka Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;

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Manoela Heringer Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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Elzinandes Leal de Azeredo Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;

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Flavia Barreto dos Santos Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

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The increase in severe dengue (SD) cases has caused great impact on public health and has concerned authorities of countries where the disease is endemic and epidemics reach high proportions. The recognition of progression signs of this severe disease during the initial febrile phase can be difficult, since the symptoms are often indistinguishable from other febrile diseases. The aim of this study was to evaluate the clinical manifestations and laboratory findings in patients from two dengue outbreaks and their association with the disease. The study was conducted in patients (n = 153) with signs and symptoms consistent with dengue occurred during two distinct epidemics, 2010 and 2013, in the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. According to the 2009 World Health Organization criteria, patients were classified as dengue without warning signs ([DwoWS] 60.6%, 57/94), dengue with warning signs ([DwWS] 30.9%, 29/94), and SD (4.25%, 4/94). Patients with DwWS/SD presented lower platelet and leukocyte counts and higher transaminase levels when compared with the DwoWS ones. Interestingly, patients from the epidemic of 2010 caused by dengue virus 2 (DENV-2) had lower platelet counts than patients of the 2013 epidemic caused by DENV-4. Furthermore, plasma leakage, gastrointestinal bleeding, and pleural effusion, hallmarks for a more severe disease, were also more frequently observed in those cases. Although previous studies may have extensively reported the wide range of the clinical aspects of dengue, the characterization of DENV-4 is desirable considering the burden of the disease during epidemics, especially for the health units and hospitals performing patient's management.

Author Notes

Address correspondence to Flavia Barreto dos Santos, Flavivirus Laboratory, Oswaldo Cruz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro 21045-360, Brazil. E-mail: flaviab@ioc.fiocruz.br
These authors contributed equally to this work.

Financial support: This work was financially supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico/CNPq (grant no. 305333/2012–7), Programa Estratégico de Pesquisa em Saúde/PAPES VI-FIOCRUZ (grant no. 407690/2012–3), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro/FAPERJ (grant no. 210.026/2014 to Rita Maria Ribeiro Nogueira), Oswaldo Cruz Foundation/FIOCRUZ and Brazilian Ministry of Health. Nieli Rodrigues da Costa Faria, Thaís Chouin-Carneiro, Manoela Heringer, and Monique da Rocha Queiroz Lima are fellows from the CoordenaçaÞo de Aperfeiçoamento de Pessoal de Nıvel Superior (CAPES), and Fernanda de Bruycker-Nogueira is a fellow from the Conselho Nacional de Desenvolvimento Cientıfico e Tecnológico/CNPq.

Authors' addresses: Nieli Rodrigues da Costa Faria, Rita Maria Ribeiro Nogueira, Fernanda de Bruycker-Nogueira, Thaís Chouin-Carneiro, Jaqueline Bastos Santos Simões, Monique da Rocha Queiroz Lima, Manoela Heringer, and Flavia Barreto dos Santos, Flavivirus Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil, E-mails: nielircf@ioc.fiocruz.br, rita@ioc.fiocruz.br, nandanog@ioc.fiocruz.br, tatachouin@gmail.com, jbsantos@paho.org, moniqueq@ioc.fiocruz.br, manoela.heringer@ioc.fiocruz.br, and flaviab@ioc.fiocruz.br. Victor Edgar Fiestas Solorzano, Luzia Maria de Oliveira Pinto, Claire Fernandes Kubelka, Elzinandes Leal de Azeredo, Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil, E-mails: vicfiso@yahoo.es, lpinto@ioc.fiocruz.br, claire@ioc.fiocruz.br, and elzinandes@ioc.fiocruz.br. Luiz José de Souza, Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil, E-mail: luizjosedes@gmail.com.

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