Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders
Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders
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DOI：
10.1016/j.ijid.2010.09.008
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发表时间：
2011-01-01
影响因子：
8.4
通讯作者：
Guzman, Maria G.
中科院分区：
文献类型：
--
作者：
Garcia, Gissel;Gonzalez, Narjara;Guzman, Maria G.
目标：登革热的急性表现是众所周知的。感染恢复期出现的临床症状尚不清楚，但可能是基于自身免疫的。本研究旨在确定 2006 年古巴流行期间感染者中持续临床症状的患病率，并评估与其发生相关的免疫和遗传因素。方法：2008 年，从 2006 年流行期间诊断为登革热（DF，n = 68）、登革出血热（DHF，n = 29）或无症状感染（AI，n = 42）。对所有个体是否存在持续症状进行了评估，并进行了心理评估。还评估了 IgG 滴度和 Fc 受体 (FcR)。在有症状个体的子集 (n = 26) 中评估以下自身免疫标志物：补体因子 C3/C4、类风湿因子 (RF)、C 反应蛋白 (CRP)、抗核抗体 (ANA) 和免疫复合物 (IC)。 结果：超过一半 (55/97) 既往诊断为 DF 或 DHF 的个体在感染后 2 年内持续出现临床症状。后遗症与最初诊断无关，在女性中更为常见（44/55）。 AI 组没有报告任何症状，所有研究参与者都有正常的心理和认知功能。持续的临床症状与 HH 多态性变异 (p = 0.027) 和高 IgG 滴度 (p = 0.041) 相关。在评估的有症状个体子集中，自身免疫标志物改变很常见 (20/26)。结论：从急性登革热病毒感染恢复后的临床后遗症在感染后 2 年内很常见。本研究获得的结果表明，持续症状与某些免疫参数和 Fc gamma RIIa 基因多态性的改变有关。这可能表明存在基于自身免疫的紊乱。 (C) 2010 年国际传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: The acute manifestations of dengue are well known. The clinical symptoms that present during the convalescent phase of infection are less well characterized, but may be autoimmune-based. This study was undertaken to determine the prevalence of persistent clinical symptoms among individuals infected during the 2006 Cuban epidemic and to evaluate the immunological and genetic factors associated with their occurrence.Methods: In 2008, clinical data and blood samples were collected from a random sample of adult individuals diagnosed during the 2006 epidemic with dengue fever (DF, n = 68), dengue hemorrhagic fever (DHF, n = 29), or an asymptomatic infection (AI, n = 42). The presence of persistent symptoms was evaluated in all individuals and a psychological assessment was performed. IgG titers and the Fc receptor (FcR) were also evaluated. The following autoimmune markers were assessed in a subset (n = 26) of symptomatic individuals: complement factors C3/C4, rheumatoid factor (RF), C-reactive protein (CRP), antinuclear antibodies (ANA), and immune complex (IC).Results: Over half (55/97) the individuals with a prior of diagnosis of DF or DHF had persistent clinical symptoms in the 2 years following infection. The sequelae were unrelated to the initial diagnosis and were more common among women (44/55). No symptoms were reported in the AI group and all study participants had normal mental and cognitive function. Persistent clinical symptoms were associated with HH polymorphic variant (p = 0.027) and high IgG titer (p = 0.041). Autoimmune marker alterations were common (20/26) in the subset of symptomatic individuals evaluated.Conclusions: Clinical sequelae after recovery from an acute dengue virus infection are common in the 2 years following infection. The results obtained in this study suggest that persistent symptoms are associated with alterations in some immunological parameters and Fc gamma RIIa gene polymorphism. This could suggest an autoimmune-based disturbance. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.