Differences in CD95L Levels and Blood Test Results in Primary and Secondary Dengue Infection Patients

Nurfadly Nurfadly, Iqrina Widia Zahara, Said Munazar Rahmad


Dengue is a disease caused by dengue virus (DENV) that is transmitted mainly by the female Aedes aegypti mosquito. There are four serotypes of DEN, leading to a possibility that a person may be infected four times by this virus, albeit with different serotypes. Recovery from infection with one viral serotype provides lifelong immunity to the same serotype but not to the other serotypes. Secondary infection by other serotypes increases the risk of developing severe dengue. The pathogenesis of severe dengue involves apoptosis of microvascular endothelial cells that leads to plasma leakage. In addition, there is usually a decrease in platelets and leukocytes and an increase in hematocrit. This study aimed to compare the results of the CD95L examination involved in the apoptotic process and the results of blood tests in primary and secondary dengue patients. This was a cross-sectional study performed in a four months period  (September–December 2019) involving several clinics and doctor's private practices in Medan, Indonesia. Subjects were eighty-four dengue patients, consisting of 18 (21%) patients with primary infection and 66 (79%) with secondary infection. Data collected were tested with the Mann Whitney test with p-value of <0.05 considered significant. A significant difference (p value=0.007) was observed in the lymphocyte counts between primary and secondary dengue patients, but no differences were seen in CDL95 level, platelet count, leukocyte count, and hematocrit. In conclusion, except for the lymphocyte count, there is no difference in CD95L level and blood test results between primary and secondary dengue patients.


Blood test, dengue, primary infection, secondary infection

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  1. WHO; World Health Organization. Dengue and Severe Dengue. [Internet] 2022. [cited 2022 March 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue.
  2. Katzelnick LC, Gresh L, Halloran ME, Mercado JC, Kuan G, Gordon A, et al. Antibody-dependent enhancement of severe dengue disease in humans. Science. 2017;358 (6365):929–32 .
  3. Azeredo EL, Monteiro RQ, Oliveira PLM. Thrombocytopenia in dengue: interrelationship between virus and the imbalance between coagulation and fibrinolysis and inflammatory mediators. Hindawi Publishing Corporation. 2015;2015:1–6.
  4. WHO. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever: WHO Regional Office for South-East Asia. Revised and expanded edition; 2011. Available from: https://apps.who.int/iris/handle/10665/204894.
  5. Nika ND, David MH. Cell death. In: Hoffman R, Benz EJ, Silbersten LE, Heslop AE, Anastasi J et al, editors. Hematology. 7th ed. Birmingham: Elsevier Inc; 2018. p. 186–96.
  6. Limonta D, Carvalho AT, Marinho CF, Azeredo EL, Souza LJ, Motta-Castro ARC, et al. Apoptotic mediators in patients with severe and non-severe dengue From Brazil. J.Med.Virol. 2014;86(8):1437–47.
  7. Zain N, Putra ST, Zein U, Hariman H. Soluble fas ligand as a potential marker of severity of dengue infection. Malays J Med Sci. 2017;24(2):28–32.
  8. Ferede G, Tiruneh M, Abate E, Wondimeneh Y, Gadisa E, et al. Study of clinical, hematological, and biochemical profiles of patients with dengue viral infections in Northwest Ethiopia: implications for patient management. BMC Infect Dis. 2018;18(616):1–6.
  9. Changal KH, Raina H, Raina A, Raina M, Bashir R, Latief M, et al. Differentiating secondary from primary dengue using IgG to IgM ratio in early dengue: an observational hospital based clinico-serological study from North India. BMC Infec Dis. 2016;16(1):715.
  10. Thai KTD, Nishiura H, Hoang PL, Tran NTT, Phan GT, et al. Age-Specificity of Clinical Dengue during Primary and Secondary Infections. PLoS Negl Trop Dis. 2011;5(6): e1180.
  11. Martha A, Yuzo A. Male-female differences in the number of reported incident dengue fever cases in six Asian countries. Western Pac Surveill Response J. 2011;2(2):17–23.
  12. Kabir MA, Zilouchian H, Younas MA, Asghar W. Dengue detection: advances in diagnostic tools from conventional technology to point of care. Biosensors. 2021;11(7):206.
  13. Narayan R, Tripathi S. Intrinsic ADE: The dark side of antibody-dependent enhancement during dengue infection. Front Cell Infect Microbiol. 2020;10:580096.
  14. Martins ST, Silveira GF, Alves LR, Santos CND, Bordignon J. Dendritic cell apoptosis and the pathogenesis of dengue. Viruses. 2012;4(11):2736–53.
  15. Rao A, Raaju RU, Gosavi S, Menon S. Dengue fever: prognostic insights from a complete blood count. Cureus. 2020;12(11):e11594.
  16. Clarice CSH, Abeysuriya V, de Mel S, Uvindu Thilakawardana B, de Mel P, et al. Atypical lymphocyte count correlates with the severity of dengue infection. PLoS One. 2019;14(5):e0215061.
  17. Chaloemwong J, Tantiworawit A, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, et al. Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study. BMC Hematol. 2018;18(20):1–10.
  18. Hensela M, Grädel L, Kutz A, Haubitz S, Huber A, Mueller B, et al. Peripheral monocytosis as a predictive factor for adverse outcome in the emergency department Survey based on a register study. Medicine. 2017;96:28.
  19. Looi KW, Matsui Y, Kono M, Samudi C, Kojima N, Onga XJ, et al. Evaluation of immature platelet fraction as a marker of dengue fever progression. Int J Infect Dis. 2021;110:187–94.
  20. Jeffrey CR, Craig BT. Pathways of apoptosis in lymphocyte development, homeostasis, and disease. Cell. 2002;109:S97–107.

DOI: https://doi.org/10.15395/mkb.v54n4.2822

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