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. 2020 Jun 29:148:e119.
doi: 10.1017/S0950268820000229.

Dengue virus co-infections with multiple serotypes do not result in a different clinical outcome compared to mono-infections

U T N Senaratne  1   2 , K Murugananthan  1   3 , P D N N Sirisena  1 , J M Carr  4 , F Noordeen  1
Affiliations

Dengue virus co-infections with multiple serotypes do not result in a different clinical outcome compared to mono-infections

U T N Senaratne et al. Epidemiol Infect. .

Abstract

Circulation of multiple dengue virus (DENV) serotypes in a locale has resulted in individuals becoming infected with mixed serotypes. This research was undertaken to study the clinical presentation, presence of DENV serotypes and serological characteristics of DENV infected patients with co-infections from three Provinces of Sri Lanka where DENV-1 and -2 predominated during the study. A reverse transcription polymerase chain reaction was performed on 1249 patient samples and 301 were positive for DENV (24.1%). DENV-1 was the predominant serotype detected in 137 (45.51%) followed by DENV-2 in 65 (21.59%), DENV-3 in 59 (19.6%) and DENV-4 in 4 (1.32%) patients with mono-infections. Thirty-three patients (10.96%) had DENV co-infections with two or more serotypes. The highest number of co-infections was noted between DENV-1 and DENV-2 (57.57%) suggesting co-infection is driven by the frequency of the circulating serotypes. Platelet counts were significantly higher in DENV co-infected patients although clinical disease severity or white blood cell count, packed cell volume or viraemia were not significantly different in the co-infected compared to the mono-infected patients. Thus co-infection with multiple DENV serotypes does occur but with the exception of improved platelet counts in co-infected patients, there is no evidence that clinical or laboratory measures of disease are altered.

Keywords: DENV co-infections; Dengue; RT-PCR; Sri Lanka.

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Conflict of interest statement

‘None.’

Figures

Fig. 1.
Fig. 1.
A flow diagram illustrating the detection of DENV infection followed by the detection of DENV mono and co-infections in the study sample; testing subsets of patients' samples using the RT-qPCR for DENV quantification and amplification by culture and DENV sero-typing.
Fig. 2.
Fig. 2.
Comparison of WBC counts between DENV mono- and co-infections analysed by the Mann–Whitney test – DENV-1 (n = 137); DENV-2 (n = 65); DENV-3 (n = 59); DENV-4 (n = 6); DENV-1 + DENV-2 (n = 11); DENV-1 + DENV-3 (n = 13); DENV-1 + DENV-4 (n = 1); DENV-2 + DENV-3 (n = 6); DENV-3 + DENV-4 (n = 1); DENV-1 + DENV-3 + DENV-4 (n = 1). DENV is given as D in the figure and that D1 = DENV-1, D2 = DENV-2, D3 = DENV-3 and D4 = DENV-4.
Fig. 3.
Fig. 3.
Comparison of platelet counts between DENV mono- and co-infections analysed by the Mann–Whitney test – DENV-1 (n = 137); DENV-2 (n = 65); DENV-3 (n = 59); DENV-4 (n = 6); DENV-1 + DENV-2 (n = 11); DENV-1 + DENV-3 (n = 13); DENV-1 + DENV-4 (n = 1); DENV-2 + DENV-3 (n = 6); DENV-3 + DENV-4 (n = 1); DENV-1 + DENV-3 + DENV-4 (n = 1); statistically significant*. DENV is given as D in the figure and that D1 = DENV-1, D2 = DENV-2, D3 = DENV-3 and D4 = DENV-4.
Fig. 4.
Fig. 4.
Comparison of PCV between DENV mono- and co-infections analysed by the Mann–Whitney test – DENV-1 (n = 137); DENV-2 (n = 65); DENV-3 (n = 59); DENV-4 (n = 6); DENV-1 + DENV-2 (n = 11); DENV-1 + DENV-3 (n = 13); DENV-1 + DENV-4 (n = 1); DENV-2 + DENV-3 (n = 6); DENV-3 + DENV-4 (n = 1); DENV-1 + DENV-3 + DENV-4 (n = 1). DENV is given as D in the figure and that D1 = DENV-1, D2 = DENV-2, D3 = DENV-3 and D4 = DENV-4.
Fig. 5.
Fig. 5.
Comparison of the viral load between mono- and co-infections with different DENV serotypes (38 patients' samples were subjected to the quantitative RT-PCR using the capsid gene primers) [20]. DENV is given as D in the figure and that D1 = DENV-1, D2 = DENV-2, D3 = DENV-3 and D4 = DENV-4.
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