Clinical and Immunological Markers of Dengue Progression in a Study Cohort from a Hyperendemic Area in Malaysia
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Date
2014-03
Authors
Rathakrishnan, Anusyah
Klekamp, Benjamin
Seok, Mui Wang
Komarasamy, Thamil Vaani
Natkunam, Santha Kumari
Sathar, Jameela
Azizan, Azliyati
Sanchez-Anguiano, Aurora
Manikam, Rishya
Devi Sekaran, Shamala
Journal Title
Journal ISSN
Volume Title
Publisher
Clinical Epidemiology of a Malaysian Dengue Cohort
Abstract
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.
Description
Keywords
Malaysia, immunological markers, dengue, Cohort
Citation
Rathakrishnan A, Klekamp B, Wang SM, Komarasamy TV, Natkunam SK, et al. (2014) Clinical and Immunological Markers of Dengue Progression in a Study Cohort from a Hyperendemic Area in Malaysia. PLoS ONE 9(3): e92021. doi:10.1371/journal.pone.0092021