Comparison of Inflammatory Cytokine Responses in DENV-1 Monoinfection Versus Coinfection with DENV-4.

PURPOSE: Dengue is a systemic vector-borne viral disease caused by infection of any one (monoinfection) or more than one serotype (coinfection) of the Dengue virus (DENV). Till date, there have been few studies, which have focused on assessing the cytokine and hematological parameters during DENV mono and coinfection giving emphasis to specific serotype combinations. This is important because all four DENV serotypes do not induce the same disease severity. Taking this into account, the current study was conducted to analyze the hematological parameters, inflammatory cytokine responses, and symptomatic variations in dengue patients of similar age who were admitted and were infected with either DENV-1 serotype or coinfected with DENV-1 and DENV-4 serotypes.

METHODS

In this cross-sectional study, samples of dengue-suspected patients were subjected to serological tests. Serologically positive or acute samples of suspected dengue were further subjected to RT-PCR serotyping, hematological, and cytokine profiling studies. The sample size for cytokine hematological and cytokine profiling studies has been estimated using G* Power 3.1.9.7 software.

RESULTS

Of the 1068 samples tested for dengue, 194 serologically positive or acute samples were further serotyped, of these, 87 samples (44.84%) tested positive in RT-PCR; 78.2% (68/87) had monoinfection, and 19 (21.8%) had coinfections. White blood cells, platelets, and neutrophil counts were significantly elevated in patients with monoinfections, and lymphocyte count was high in coinfection. Interleukin 8 (IL-8) and IL-6 were high in monoinfections, and IL-10 and interferon γ were higher in coinfections.

CONCLUSION

Findings of the present study indicate that there was a better antiviral immune response during coinfections in comparison to monoinfection cases. However, further research with a larger number of coinfections is needed to make a reliable comparison between each combination of mixed serotypes, which will help understand the disease kinetics in DENV coinfections.