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COMMENTARY |
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Year : 2016 | Volume
: 9
| Issue : 5 | Page : 594-595 |
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Differentiating primary and secondary dengue infections: Why and how?
Harshal S Mandavdhare, Vishal Sharma
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Date of Web Publication | 13-Oct-2016 |
Correspondence Address: Vishal Sharma Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.192145
How to cite this article: Mandavdhare HS, Sharma V. Differentiating primary and secondary dengue infections: Why and how?. Med J DY Patil Univ 2016;9:594-5 |
Dengue viral infections are important mosquito-borne diseases in the world. Recent reports suggest an upsurge in cases of complicated dengue infection in various parts of the world. Furthermore, a vast majority of cases are in the children or productive ages, thereby significant morbidity and mortality and loss of work-hours among the afflicted.
[1] The spectrum of clinical manifestation ranges from nonsevere dengue fever to severe forms as dengue hemorrhagic fever and dengue shock syndrome. Serologically, primary infection is characterized by rise in dengue-specific IgM antibody within 4–5 days of fever onset, followed by rise of IgG antibody with 7–10 days. The diagnosis of primary dengue in the initial 5 days, therefore, requires utilization of polymerase chain reaction techniques (RT-PCR) or antigen detection, especially the NS1 antigen whereas secondary infection is recognized by an early rise in the IgG antibody titer and a lower titer of IgM rise. Again, early phases of secondary dengue also show PCR and NS1 positivity [Table 1].[2]
Several studies have found significant differences in clinical presentation between primary and secondary infections. Many reports suggest that secondary dengue may result in more sinister manifestations and a complicated course. A large pediatric study from Thailand showed significant difference between the age of presentation; primary infection had mean age of 4.8 ± 4.3 years while secondary infection had mean age of 8.6 ± 3.2 years, suggesting secondary infection to be more common among elder children. The presenting symptoms also differed between the groups with primary presenting with coryza, rash, fever, diarrhea, and seizure while secondary presenting with vomiting, headache, and abdominal pain. This pattern of presentation suggests that secondary infection typically has warning signs that suggest plasma leak and subsequent development of complicated course. In addition, this study highlighted that primary infection predominantly presented with dengue fever (22% vs. 10%) while secondary infection presented more often with Grade 3 dengue hemorrhagic fever.[3] The present study by Bandaru and Vanumul also reiterates the above findings that severe complications of dengue infection in the form of dengue hemorrhagic fever (DHF) and encephalopathy were significantly more common in secondary infection. Further, out of the four deaths, three were seen in secondary infection complicated by DHF.[4] Another study by Cordeiro et al. showed that severe complications of dengue infection such as DHF are more common with sequential infections.[5] A few reports have also compared liver enzyme elevations in primary and secondary dengue and have reported conflicting results.[6] While one large report of 1585 cases suggested that sequential infections resulted in a greater alteration in liver enzymes, another report from Vietnam suggested that the differences were inconsequential.[7],[8] A meta-analysis suggested that secondary infections with serotypes DENV-2, -3, and -4 were likely to result in severe dengue infections.[9]
The management of dengue is primarily based on alleviation of symptoms, recognizing and treating complications, and supportive care. Even in the absence of any specific therapy, history or evidence of previous dengue infection may identify a subgroup of population at risk for a more severe course in some of the cases.
References | | |
1. | Giri S, Sharma V, Easow B, Agarwal MP, Sharma A. Low mortality during 2008 outbreak of dengue in Delhi, India: A clinico-biochemical study. Rev Cien Méd Biol 2010;9:10-2. |
2. | |
3. | Pancharoen C, Mekmullica J, Thisyakorn U. Primary dengue infection: What are the clinical distinctions from secondary infection? Southeast Asian J Trop Med Public Health 2001;32:476-80. |
4. | Bandaru AK, Vanumul CS. Early predictors to differentiate primary from secondary dengue infection in children. Med J DY Patil Univ 2016. |
5. | Cordeiro MT, Braga-Neto U, Nogueira RM, Marques ET Jr. Reliable classifier to differentiate primary and secondary acute dengue infection based on IgG ELISA. PLoS One 2009;4:e4945. |
6. | Samanta J, Sharma V. Dengue and its effects on liver. World J Clin Cases 2015;3:125-31. |
7. | Nguyen TL, Nguyen TH, Tieu NT. The impact of dengue haemorrhagic fever on liver function. Res Virol 1997;148:273-7. |
8. | Souza LJ, Alves JG, Nogueira RM, Gicovate Neto C, Bastos DA, Siqueira EW, et al. Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases. Braz J Infect Dis 2004;8:156-63. |
9. | Soo KM, Khalid B, Ching SM, Chee HY. Meta-analysis of dengue severity during infection by different dengue virus serotypes in primary and secondary infections. PLoS One 2016;11:e0154760. |
[Table 1]
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