{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T22:39:48Z","timestamp":1782167988745,"version":"3.54.5"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,7,12]]},"abstract":"<jats:p>The increase in severe dengue (SD) cases has caused great impact on public health and has concerned authorities of countries where the disease is endemic and epidemics reach high proportions. The recognition of progression signs of this severe disease during the initial febrile phase can be difficult, since the symptoms are often indistinguishable from other febrile diseases. The aim of this study was to evaluate the clinical manifestations and laboratory findings in patients from two dengue outbreaks and their association with the disease. The study was conducted in patients (<jats:italic>n<\/jats:italic> = 153) with signs and symptoms consistent with dengue occurred during two distinct epidemics, 2010 and 2013, in the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. According to the 2009 World Health Organization criteria, patients were classified as dengue without warning signs ([DwoWS] 60.6%, 57\/94), dengue with warning signs ([DwWS] 30.9%, 29\/94), and SD (4.25%, 4\/94). Patients with DwWS\/SD presented lower platelet and leukocyte counts and higher transaminase levels when compared with the DwoWS ones. Interestingly, patients from the epidemic of 2010 caused by dengue virus 2 (DENV-2) had lower platelet counts than patients of the 2013 epidemic caused by DENV-4. Furthermore, plasma leakage, gastrointestinal bleeding, and pleural effusion, hallmarks for a more severe disease, were also more frequently observed in those cases. Although previous studies may have extensively reported the wide range of the clinical aspects of dengue, the characterization of DENV-4 is desirable considering the burden of the disease during epidemics, especially for the health units and hospitals performing patient's management.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0227","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T07:00:19Z","timestamp":1491894019000},"page":"137-145","source":"Crossref","is-referenced-by-count":12,"title":["Analysis of Clinical and Laboratory Alterations Related to Dengue Case Severity: Comparison between Serotypes 2 and 4 in Brazil"],"prefix":"10.4269","volume":"97","author":[{"given":"Nieli Rodrigues","family":"da Costa Faria","sequence":"first","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Edgar Fiestas","family":"Solorzano","sequence":"additional","affiliation":[{"name":"Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Jos\u00e9","family":"de Souza","sequence":"additional","affiliation":[{"name":"Flavivirus Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita Maria Ribeiro","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda","family":"de Bruycker-Nogueira","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tha\u00eds","family":"Chouin-Carneiro","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline Bastos","family":"Santos Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"da Rocha Queiroz Lima","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luzia Maria","family":"de Oliveira Pinto","sequence":"additional","affiliation":[{"name":"Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire Fernandes","family":"Kubelka","sequence":"additional","affiliation":[{"name":"Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoela","family":"Heringer","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elzinandes Leal","family":"de Azeredo","sequence":"additional","affiliation":[{"name":"Hospital dos Plantadores de Cana, Campos dos Goytacazes, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Barreto dos Santos","sequence":"additional","affiliation":[{"name":"Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, Brazil Oswaldo Cruz Institute, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"PLoS Negl Trop Dis","first-page":"e1760","article-title":"Refining the global spatial limits of dengue virus transmission by evidence-based consensus","volume":"6","author":"Brady","year":"2012"},{"key":"ref2","series-title":"Nature","first-page":"504","article-title":"The global distribution and burden of dengue","volume":"496","author":"Bhatt","year":"2013"},{"issue":"(Suppl)","key":"ref3","series-title":"Nat Rev Microbiol","first-page":"S7","article-title":"Dengue: a continuing global threat","volume":"8","author":"Guzman","year":"2010"},{"key":"ref4","series-title":"Number of Reported Cases of Dengue and Severe Dengue (SD) in the Americas, by Country: Epidemiological Week\/EW 5 February 3, 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