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Volume 42, Number 6, December 2009

Effect of serotypes on clinical manifestations of dengue fever in adults

Kah-Sieong Chan1, Jung-San Chang, Ko Chang, Chien-Chou Lin, Jyh-Hsiung Huang, Wei-Ru Lin, Tun-Chieh Chen, Hsiao-Chen Hsieh, Shu-Hui Lin, Ju-Chuen Lin, Po-Liang Lu,Yen-Hsu Chen, Chun-Yu Lin, Jih-Jin Tsai

Received: August 1, 2008    Revised: August 26, 2008    Accepted: August 31, 2008   


Corresponding author:

Dr. Jih-Jin Tsai, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou First Rd., Kaohsiung 80756, Taiwan. E-mail:


Background and purpose: 

Dengue fever (DF) is a major public health issue. However, it is unclear whether different dengue virus serotypes (DENV) are associated with different clinical manifestations and outcomes. This study investigated the association between viral serotype and clinical manifestations of DF.



Adult patients with DENV-2 and DENV-3 who were treated at Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan, from January 1998 to September 2007 were enrolled. The patients’ demographic data, underlying diseases, clinical manifestations, laboratory data, and disease outcomes were retrospectively analyzed.



 294 patients had DENV-2 and 91 had DENV-3. The median age was 50 years, and 45.7% of patients were men. Patients with DENV-3 were more likely to have a malignancy (p= 0.011), myalgia (p= 0.03), skin rash (p< 0.001), ascites (p= 0.04), and fever (p= 0.003) than patients with DENV-2. Patients with DENV-3 had their lowest levels of white blood cells and platelets, and peak plasma activated partial thromboplastin time (aPTT) 1 day later than patients with DENV-2. DENV-2 infection was associated with a higher monocyte count and more prolonged aPTT early in the clinical course. Infection by DENV-2 more commonly occurred as a secondary infection, while infection by DENV-3 was more common as a primary infection (p< 0.001). There were no differences between the groups in organ involvement, disease severity, duration of hospital stay, and medical expenditure.


The symptoms, signs, and laboratory findings appear to be different for patients infected with DENV-2 and DENV-3, but there is no difference in outcomes. 


Key words:

Dengue; Dengue hemorrhagic fever; Dengue virus