Evaluation of inflammatory and coagulation mediators in 2013 dengue virus type 4 outbreak

Dengue has become the most widespread arbovirus in the world, reaching more than100 countries. The DENV-4 serotype was reintroduced in Brazil in 2010, and spreadto the different Brazilian regions being responsible for one of the largest epidemics ofdengue reported in the country in 2013. The objective of this study was to evaluatethe clinical and laboratory profile, and inflammatory cytokines/chemokines andcoagulation mediators in patients infected with DENV during this epidemic. For this,were evaluated 265 confirmed cases of dengue attended at health centers in thestates of RJ and MS in the year 2013. Patients were classified according to the newWHO classification, 2009 in groups: 158 (70.2 percent) dengue without warning signs(DwoWS), 65 (28.9 percent) dengue with warning signs (DwWS) and 2 (0.9 percent) severedengue (SD). The most frequent warning signals were persistent abdominal pain(61.5 percent) and mucosal bleeding (32.3 percent). The DENV-4 was the most prevalentserotype and 85,2 percent of dengue patients showed secondary infection. DwWS/SDpatients showed lower white blood cell and platelet counts, and higher AST and ALTserum levels compared to DwoWS and other febrile illnesses patients. Quantificationof inflammatory mediators by immunoassays indicated: (i) increased levels ofcytokines (TNF-alpha, IL-6 and IL-10) and chemokines (IL-8/CXCL8, IP-10/CXCL10 andMCP-1/CCL2) in DwoWS and DwWS patients compared with healthy individuals; (ii)increased levels of IL-10 and IL-6 in DwWS/SD patients while IL-8/CXCL8 wasincreased in DSSA patients; In respect to coagulation parameters: (iii) DwoWS andDwWS/SD patients showed lower levels of sTF and higher of TFPI compared withthe control group; (iv) Lower levels of fibrinogen were found in DwWS/SD patientsand higher levels of thrombomodulin in patients between 4-7 days of illness...