Clinical and immunological markers of dengue progression in a study cohort from a hyperendemic area in Malaysia.

Autor: Rathakrishnan A; Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Klekamp B; Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America., Wang SM; Institute of Medical Molecular Biotechnology, Faculty of Medicine, University Technology Mara, Selangor, Malaysia., Komarasamy TV; Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Natkunam SK; Hospital Tengku Ampuan Rahimah, Persiaran Tengku Ampuan Rahimah, Klang, Selangor., Sathar J; Clinical Hematology Laboratory, Department of Hematology, Hospital Ampang, Ampang, Selangor, Malaysia., Azizan A; Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America., Sanchez-Anguiano A; Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America., Manikam R; Department of Trauma and Emergency Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Sekaran SD; Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2014 Mar 19; Vol. 9 (3), pp. e92021. Date of Electronic Publication: 2014 Mar 19 (Print Publication: 2014).
DOI: 10.1371/journal.pone.0092021
Abstrakt: Background: With its elusive pathogenesis, dengue imposes serious healthcare, economic and social burden on endemic countries. This study describes the clinical and immunological parameters of a dengue cohort in a Malaysian city, the first according to the WHO 2009 dengue classification.
Methodology and Findings: This longitudinal descriptive study was conducted in two Malaysian hospitals where patients aged 14 and above with clinical symptoms suggestive of dengue were recruited with informed consent. Among the 504 participants, 9.3% were classified as non-dengue, 12.7% without warning signs, 77.0% with warning signs and 1.0% with severe dengue based on clinical diagnosis. Of these, 37% were misdiagnosed as non-dengue, highlighting the importance of both clinical diagnosis and laboratory findings. Thrombocytopenia, prolonged clotting time, liver enzymes, ALT and AST served as good markers for dengue progression but could not distinguish between patients with and without warning signs. HLA-A*24 and -B*57 were positively associated with Chinese and Indians patients with warning signs, respectively, whereas A*03 may be protective in the Malays. HLA-A*33 was also positively associated in patients with warning signs when compared to those without. Dengue NS1, NS2A, NS4A and NS4B were found to be important T cell epitopes; however with no apparent difference between with and without warning signs patients. Distinction between the 2 groups of patients was also not observed in any of the cytokines analyzed; nevertheless, 12 were significantly differentially expressed at the different phases of illness.
Conclusion: The new dengue classification system has allowed more specific detection of dengue patients, however, none of the clinical parameters allowed distinction of patients with and without warning signs. While the HLA-A*33 may be predictive marker for development of warning signs; larger studies will be needed to support this findings.
Databáze: MEDLINE
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