High Circulating Levels of the Dengue Virus Nonstructural Protein NS1 Early in Dengue Illness Correlate with the Development of Dengue Hemorrhagic Fever
Daniel H. Libratya b, Paul R. Youngc, Darren Pickeringc, Timothy P. Endyd, Siripen Kalayanarooje, Sharone Greenf, David W. Vaughng, Ananda Nisalakd, Francis A. Ennisf, Alan L. Rothmanf
- aCenter for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, 55 Lake Avenue N., Worcester, MA 01655, USA. daniel.libraty@umassmed.edu
- bCenter for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, 55 Lake Avenue N., Worcester, MA 01655, USA
- cDepartment of Microbiology & Parasitology, University of Queensland, Brisbane, Australia
- dDepartment of Virology, Armed Forces Research Institute of Medical Sciences, and
- eDepartment of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
- fCenter for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester
- gDepartment of Virus Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Abstract
Infection with any 1 of 4 dengue viruses produces a spectrum of clinical illness ranging from a mild undifferentiated febrile illness to dengue fever (DF) to dengue hemorrhagic fever (DHF), a potentially life-threatening disease. The morbidity and mortality of DHF can be reduced by early hospitalization and careful supportive care. To determine its usefulness as a predictor of DHF, plasma levels of the secreted dengue virus nonstructural protein NS1 (sNS1) were measured daily in 32 children with dengue-2 virus infections participating in a prospective, hospital-based study. Free sNS1 levels in plasma correlated with viremia levels and were higher in patients with DHF than in those with DF. An elevated free sNS1 level (> or =600 ng/mL) within 72 h of illness onset identified patients at risk for developing DHF.