Secondary DENV Infections Along with Concurrent Multiple DENV Serotypes in a Single Dengue Session Contributing to Dengue Severity in Chittagong Bangladesh

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Moushumi Ghosh Roy, Kutub Uddin, Din Islam, M. Monirul Islam, Anjuvan Singh

Abstract

Introduction: Natural anti-DENV antibodies might provide long-lasting immunity against the infecting DENV serotype. However, the rationale for infecting DENV serotypes and anti-DENV antibody responses is still missing. Here, we investigated anti-DENV IgG and IgM antibodies along with infecting DENV serotypes and clinical dengue manifestation in recent dengue outbreaks in Chittagong, Bangladesh.


Methods: The 112 samples investigated were confirmed dengue cases who were hospitalized. The infecting DENV serotyping was done by the ratio of anti-DENV IgG and IgM antibodies determined by ELISA as well as by RT-PCR. A hematology cell counter was used for differential blood cell counts following DENV infection.


Results: DENV serotyping based on anti-DENV IgM/IgG antibodies developed following DENV infection indicated that, first, 35% of primary DENV infections, 65% of sera tested had secondary DENV infections, secondly, among the primary DENV infections 51% had single DENV infection where the most prevailed serotype was DENV4 and 49% had concurrent multiple DENV infections where 70% of cases had DENV1 serotype along with other serotypes. There was no strong correlation between clinical dengue manifestation and infecting DENV serotype. However, patients infected with DENV1 had rapid and progressive loss of platelets in the course of dengue infections (days 0-4).


Conclusion: Very high occurrence of secondary DENV infection cases suggested that Bangladesh has been experiencing recurrent DENV infection being contributed by cross-reacting primary anti-DENV antibodies through ADE. Furthermore, the presence of multiple of DENV serotypes and concurrent multiple DENV infections in a single dengue session might be the reason for increased dengue disease incidence and dengue severity in Chittagong, Bangladesh.

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