Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.
J Travel Med. 2023 Nov 18;30(7). doi: 10.1093/jtm/taad129.
Dengue fever (DF), caused by the dengue virus (DENV), is the most common arboviral disease in travellers worldwide. It is hypothesized that compared with primary DF, secondary DF may result in antibody-dependent enhancement of the immune response, resulting in more severe disease. We aimed to compare clinical and laboratory parameters in travellers with primary and secondary DF to determine whether secondary DF is associated with markers of severe disease.
We conducted a retrospective cohort study, which included all patients diagnosed with DF at the Central Virology Laboratory of the Israeli Ministry of Health during 2008-19. Clinical, laboratory and virological data were extracted from laboratory and patient records. A diagnosis of DENV infection was based on a positive nonstructural protein 1 (NS1) test, polymerase chain reaction or serology testing for immunoglobulin M (IgM) and immunoglobulin G (IgG). Primary and secondary infections were classified based on travel history, NS1 result and IgM/IgG ratio. Severe DF was defined according to WHO classification.
We identified 245 DF cases: 210 (86%) primary and 35 (14%) secondary. Whilst fever duration was significantly longer in secondary compared with primary infections (6.4 vs 5.3 days, P = 0.027), mean Aspartate aminotransferase levels were significantly higher in primary compared with secondary cases (146 vs 65 U/L, P < 0.001), and no other clinical or laboratory parameter differed significantly between the groups. Of note, only four patients had severe DF, all had primary infections and none died.
In a cohort of returning travellers with DF, secondary infection, compared with primary infection, was not associated with a consistent trend towards greater severity of the clinical and laboratory markers examined in this study.
登革热（DF）是由登革病毒（DENV）引起的，是全球旅行者中最常见的虫媒病毒病。据推测，与原发性 DF 相比，继发性 DF 可能导致免疫反应的抗体依赖性增强，从而导致更严重的疾病。我们旨在比较旅行者中原发性和继发性 DF 的临床和实验室参数，以确定继发性 DF 是否与严重疾病的标志物有关。
我们进行了一项回顾性队列研究，该研究包括 2008 年至 2019 年期间在以色列卫生部中央病毒学实验室诊断为 DF 的所有患者。从实验室和患者记录中提取临床、实验室和病毒学数据。DENV 感染的诊断基于非结构蛋白 1（NS1）检测、聚合酶链反应或免疫球蛋白 M（IgM）和免疫球蛋白 G（IgG）的血清学检测阳性。原发性和继发性感染是根据旅行史、NS1 结果和 IgM/IgG 比值进行分类的。严重 DF 根据世界卫生组织的分类进行定义。
我们确定了 245 例 DF 病例：210 例（86%）为原发性，35 例（14%）为继发性。虽然继发性感染的发热持续时间明显长于原发性感染（6.4 天 vs 5.3 天，P=0.027），但原发性感染的天冬氨酸转氨酶水平明显高于继发性感染（146 U/L vs 65 U/L，P<0.001），两组之间没有其他临床或实验室参数有显著差异。值得注意的是，只有 4 例患者患有严重 DF，均为原发性感染，且无人死亡。
在返回旅行者中，与原发性感染相比，继发性感染与本研究中检查的临床和实验室标志物的严重程度增加没有一致趋势。
