Dengue viremia titer, antibody response pattern, and virus serotype correlate with disease severity

Viremia titers in serial plasma samples from 168 children with acute dengue virus infection who were enrolled in a prospective study at 2 hospitals in Thailand were examined to determine the role of virus load in the pathogen esis of dengue hemorrhagic fever (DHF), The infecting virus serotype was id entified for 165 patients (DEN-1, 46 patients; DEN-2, 47 patients; DEN-3, 4 7 patients, DEN-4, 25 patients), Patients with DEN-2 infections experienced more severe disease than those infected with other serotypes, Eighty-one p ercent of patients experienced a secondary dengue virus infection that was associated with more severe disease. Viremia titers were determined for 41 DEN-1 and 46 DEN-2 patients. Higher peak titers were associated with increa sed disease severity for the 31 patients with a peak titer identified (mean titer of 10(7.6) for those with dengue fever vs. 10(8.5) for patients with DHF, P = .01), Increased dengue disease severity correlated with high vire mia titer, secondary dengue virus infection, and DEN-2 virus type.