11 research outputs found
Hyperferritinaemia in Dengue Virus Infected Patients Is Associated with Immune Activation and Coagulation Disturbances
During a dengue outbreak on the Caribbean island Aruba, highly elevated levels of ferritin were detected in dengue virus infected patients. Ferritin is an acute-phase reactant and hyperferritinaemia is a hallmark of diseases caused by extensive immune activation, such as haemophagocytic lymphohistiocytosis. The aim of this study was to investigate whether hyperferritinaemia in dengue patients was associated with clinical markers of extensive immune activation and coagulation disturbances.Levels of ferritin, standard laboratory markers, sIL-2R, IL-18 and coagulation and fibrinolytic markers were determined in samples from patients with uncomplicated dengue in Aruba. Levels of ferritin were significantly increased in dengue patients compared to patients with other febrile illnesses. Moreover, levels of ferritin associated significantly with the occurrence of viraemia. Hyperferritinaemia was also significantly associated with thrombocytopenia, elevated liver enzymes and coagulation disturbances. The results were validated in a cohort of dengue virus infected patients in Brazil. In this cohort levels of ferritin and cytokine profiles were determined. Increased levels of ferritin in dengue virus infected patients in Brazil were associated with disease severity and a pro-inflammatory cytokine profile.Altogether, we provide evidence that ferritin can be used as a clinical marker to discriminate between dengue and other febrile illnesses. The occurrence of hyperferritinaemia in dengue virus infected patients is indicative for highly active disease resulting in immune activation and coagulation disturbances. Therefore, we recommend that patients with hyperferritinaemia are monitored carefully
Epidemiology of Guillain-Barre Syndrome in Aruba
The epidemiology of GuillainâBarrĂ© syndrome (GBS) in tropical areas is different compared with developed countries. We investigated the epidemiology of GBS on the Caribbean island of Aruba. Data were collected retrospectively from all 36 patients hospitalized with GBS between 2003 and 2011 in Aruba. We observed a seasonal distribution of GBS cases with a peak in February. The incidence rate (IR) fluctuated heavily between individual years. The overall IR was 3.93/100,000, which is higher than that observed in developed countries. Serological studies indicated a possible relation of GBS cases with dengue virus infections. We also observed a relation between the annual number of dengue cases in Aruba and the number of GBS cases in the same year. We conclude that the epidemiology of GBS in tropical areas can be different from temperate climate regions and that dengue may be a trigger for developing GBS
Hyperferritinaemia in dengue virus infected patients is associated with immune activation and coagulation disturbances
During a dengue outbreak on the Caribbean island Aruba, highly elevated levels of ferritin were detected in dengue virus infected patients. Ferritin is an acute-phase reactant and hyperferritinaemia is a hallmark of diseases caused by extensive immune activation, such as haemophagocytic lymphohistiocytosis. The aim of this study was to investigate whether hyperferritinaemia in dengue patients was associated with clinical markers of extensive immune activation and coagulation disturbances. Levels of ferritin, standard laboratory markers, sIL-2R, IL-18 and coagulation and fibrinolytic markers were determined in samples from patients with uncomplicated dengue in Aruba. Levels of ferritin were significantly increased in dengue patients compared to patients with other febrile illnesses. Moreover, levels of ferritin associated significantly with the occurrence of viraemia. Hyperferritinaemia was also significantly associated with thrombocytopenia, elevated liver enzymes and coagulation disturbances. The results were validated in a cohort of dengue virus infected patients in Brazil. In this cohort levels of ferritin and cytokine profiles were determined. Increased levels of ferritin in dengue virus infected patients in Brazil were associated with disease severity and a pro-inflammatory cytokine profile. Altogether, we provide evidence that ferritin can be used as a clinical marker to discriminate between dengue and other febrile illnesses. The occurrence of hyperferritinaemia in dengue virus infected patients is indicative for highly active disease resulting in immune activation and coagulation disturbances. Therefore, we recommend that patients with hyperferritinaemia are monitored carefull
Hyperferritinaemia is associated with certain markers of HLH and MAS.
<p>The platelet count (A) was significantly decreased and the liver enzyme ASAT (C) significantly increased in patients with hyperferritinaemia compared to patients with no hyperferritinaemia and OFI at each time point in the cohort from Aruba. Levels of fibrinogen were significantly decreased in patients with hyperferritinaemia compared to patients without hyperferritinaemia at day 6â8 (B). Levels of ALAT were significantly increased in patients with hyperferritinaemia at day 4â5 and 6â8 (D). Levels of sIL-2R were significantly increased in patients with hyperferritinaemia compared to OFI at day 2â3 (E). Levels of IL-18 were significantly increased in patients with no hyperferritinaemia compared to OFI at day 2â3 and in patients with hyperferritinaemia compared to OFI at day 4â5 (F). Missing values: Platelet count, ASAT, ALAT: no missing values. sIL-2R and IL-18: Day 2â3: No HF (Nâ=â3), HF (Nâ=â2). Day 4â5: No HF (Nâ=â5), HF (Nâ=â3). Area between two dotted horizontal lines: interquartile range from the autologous control group. Boxplots indicate the interquartile range, the horizontal line inside the box indicates the median. The whiskers reach from the 10<sup>th</sup> till the 90<sup>th</sup> percentile. P-valueâ€0.006 is considered significant.</p
Ferritin levels and fold change are associated with viraemia.
<p>The absolute ferritin levels were significantly increased in viraemic patients compared to non-viraemic patients at day 6â8 (A) and the ferritin fold change was significantly elevated in viraemic patient at each time point (B) in the cohort from Aruba. Area between two dotted horizontal lines: interquartile range from the autologous control group. Boxplots indicate the interquartile range. The horizontal line inside the box indicates the median. The whiskers reach from the 10<sup>th</sup> till the 90<sup>th</sup> percentile. P-valueâ€0.02 is considered significant.</p
General characteristics cohort Aruba.
<p>In one patient ferritin levels were not determined. Abbreviations: WSââ=ânon-severe dengue without warning signs. WS+â=ânon-severe dengue with warning signs, OFIâ=âother febrile illness, Fâ=âFisher's exact test, Chiâ=âChi-squared test, DENVâ=âdengue virus.</p><p>*â=âValues are in median (interquartile range).</p><p>General characteristics cohort Aruba.</p