{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:53:25Z","timestamp":1780476805881,"version":"3.54.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T00:00:00Z","timestamp":1563926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro","doi-asserted-by":"publisher","award":["E-26\/202.930\/2016"],"award-info":[{"award-number":["E-26\/202.930\/2016"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["402571\/2011-8"],"award-info":[{"award-number":["402571\/2011-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Since 1981, &gt;12 million cases of dengue have been reported in Brazil. Early prediction of severe dengue with no warning signs is crucial to avoid progression to severe dengue. Here we aimed to identify early markers of dengue severity and characterize dengue infection in patients in Rio de Janeiro.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated early severity markers, serotypes, infection status, number of days of illness and viral loads associated with dengue fever in patients from Rio de Janeiro, Brazil through an observational retrospective study (1986\u20132012). We compared dengue without warning signs and dengue with warning signs\/severe dengue (DWWS\/SD). Infection status was classified by enzyme-linked immunosorbent assay and viraemia was quantified by quantitative real-time reverse transcription polymerase chain reaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The presence of DWWS\/ SD was significantly associated with younger age; patients 13\u201319 y of age had a significantly greater chance of presenting warning signs. Dengue virus type 3 (DENV3) was more likely to induce DWWS\/SD, which was more frequent on days 4\u20135 of illness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>DENV3, 4\u20135 d of illness and 13\u201319 y of age were early biomarkers of dengue severity. To our knowledge, this was the first study to analyse the characteristics of dengue severity in the state of Rio de Janeiro over 27 y of epidemics since the introduction of DENV.<\/jats:p><\/jats:sec>","DOI":"10.1093\/trstmh\/trz066","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T20:26:00Z","timestamp":1561494360000},"page":"670-677","source":"Crossref","is-referenced-by-count":5,"title":["Factors predicting the severity of dengue in patients with warning signs in Rio de Janeiro, Brazil (1986\u20132012)"],"prefix":"10.1093","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3135-8008","authenticated-orcid":false,"given":"Bianca De Santis","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita Maria Ribeiro","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Bispo de Filippis","sequence":"additional","affiliation":[{"name":"Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Aur\u00e9lio Pereira","family":"Horta","sequence":"additional","affiliation":[{"name":"Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Av Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,24]]},"reference":[{"issue":"7446","key":"2019110708161702100_trz066C1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"Bhatt","year":"2013","journal-title":"Nature"},{"issue":"Pt 1","key":"2019110708161702100_trz066C2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1099\/0022-1317-70-1-37","article-title":"Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera","volume":"70","author":"Calisher","year":"1989","journal-title":"J Gen Virol"},{"key":"2019110708161702100_trz066C3","first-page":"223","volume-title":"Epidemiology of arthropod-borne viral diseases","author":"Gubler","year":"1988"},{"issue":"3407","key":"2019110708161702100_trz066C4","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1126\/science.131.3407.1102","article-title":"Viruses associated with epidemic hemorrhagic fevers of the Philippines and Thailand","volume":"131","author":"Hammon","year":"1960","journal-title":"Science"},{"key":"2019110708161702100_trz066C5","volume-title":"Dengue guidelines for diagnosis, treatment, prevention and control: new edition","author":"World Health Organization, Special Programme for Research and Training in Tropical Diseases","year":"2009"},{"key":"2019110708161702100_trz066C6","author":"Pan American Health Organization"},{"issue":"5","key":"2019110708161702100_trz066C7","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/tropej\/fmx078","article-title":"Clinical and laboratory factors associated with severe dengue: a case-control study of hospitalized children","volume":"64","author":"Wakimoto","year":"2017","journal-title":"J Trop Pediatr"},{"issue":"9188","key":"2019110708161702100_trz066C8","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/S0140-6736(99)04015-5","article-title":"Failure of secondary infection with American genotype dengue 2 to cause dengue haemorrhagic fever","volume":"354","author":"Watts","year":"1999","journal-title":"Lancet"},{"issue":"1","key":"2019110708161702100_trz066C9","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4269\/ajtmh.2011.10-0476","article-title":"Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam","volume":"84","author":"Anders","year":"2011","journal-title":"Am J Trop Med Hyg"},{"issue":"5","key":"2019110708161702100_trz066C10","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/0035-9203(87)90041-1","article-title":"Why dengue haemorrhagic fever in Cuba? 1. 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