Roles of Interferons in Pregnant Women with Dengue Infection: Protective or Dangerous Factors

Canadian Journal of Infectious Diseases and Medical Microbiology, Sep 2017

Dengue infection is a serious public health problem in tropical and subtropical areas. With the recent outbreaks of Zika disease and its reported correlation with microcephaly, the large number of pregnancies with dengue infection has become a serious concern. This review describes the epidemiological characteristics of pregnancy with dengue and the initial immune response to dengue infection, especially in IFNs production in this group of patients. Dengue is much more prevalent in pregnant women compared with other populations. The severity of dengue is correlated with the level of IFNs, while the serum IFN level must be sufficiently high to maintain the pregnancy and to inhibit virus replication.

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Roles of Interferons in Pregnant Women with Dengue Infection: Protective or Dangerous Factors

Roles of Interferons in Pregnant Women with Dengue Infection: Protective or Dangerous Factors Hao Zhang,1 Zhiyi He,2 Wenting Zeng,1 and Hong-Juan Peng3 1Department of Infectious Diseases, The Key Discipline of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 151 Yanjiang Road, Guangdong Province 510120, China 2Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 151 Yanjiang Road, Guangdong Province 510120, China 3Guangdong Provincial Key Laboratory of Tropical Disease Research and Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, School of Public Health and Tropical Medicine, Southern Medical University, No. 1023 South Shatai Road, Guangzhou, Guangdong Province 510515, China Correspondence should be addressed to Wenting Zeng; moc.361@55854690631 and Hong-Juan Peng; nc.ude.ums@naujgnoh Received 15 June 2017; Revised 1 August 2017; Accepted 6 August 2017; Published 7 September 2017 Academic Editor: Maria L. Tornesello Copyright © 2017 Hao Zhang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Dengue infection is a serious public health problem in tropical and subtropical areas. With the recent outbreaks of Zika disease and its reported correlation with microcephaly, the large number of pregnancies with dengue infection has become a serious concern. This review describes the epidemiological characteristics of pregnancy with dengue and the initial immune response to dengue infection, especially in IFNs production in this group of patients. Dengue is much more prevalent in pregnant women compared with other populations. The severity of dengue is correlated with the level of IFNs, while the serum IFN level must be sufficiently high to maintain the pregnancy and to inhibit virus replication. 1. Background Dengue is a febrile disease that is transmitted by Aedes mosquitoes. It is estimated that approximately 3900 million people in 128 countries are at risk of infection by dengue viruses [1]. This virus infects approximately 390 million people per year, 96 million of whom present disease [2]. The causative agent of dengue is dengue virus (DENV), which belongs to the family Flaviviridae. The clinical phenotype of dengue varies from a self-limiting febrile illness to severe, occasionally life-threatening disease. Typically, symptomatic disease follows three phases: a febrile phase lasting 3 to 7 days; a critical phase characterized by defervescence, during which complications appear in a small proportion of patients; and a spontaneous recovery phase. Complications primarily affect the vascular system and include an unusual plasma leakage syndrome that may result in dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), which are classified as severe dengue according to the WHO guidelines for dengue diagnosis, treatment, and prevention [3, 4]. In 2015-2016, Zika virus caused large outbreaks in Pacific areas and in Central and South America [5]. Increasing data have shown that Zika virus infection is associated with adverse pregnancy outcomes such as fetal death, premature birth, and microcephalus [6]. Thus, DENV infection which belongs to the same family of Flaviviridae as Zika virus has become a serious concern in pregnant women. 2. Dengue in Pregnant Woman With an estimated yearly case number of 390 million from more than 100 countries and regions in Asia, Oceania, America, and Africa, dengue fever (DF) is now one of the most important vector-borne diseases worldwide [2]. As reported in recent studies, a high rate of dengue infection has been observed in pregnant women. An investigation of 358 pregnant women in Malaysia, a dengue endemic country, showed that a seropositivity for dengue infection of approximately 35.8% by ELISA [7]. Additionally, in another dengue endemic country, Thailand, the dengue seroprevalence can reach 90.3% [8]. It must be noted, however, that these data were collected during the Chikungunya disease outbreak [8], raising the possibility of false positivity. In the African country, the Democratic Republic of Sao Tome and Principe, 39.74% of pregnant women were found to be positive for DENV antibodies [9]. These findings indicate that pregnant women have high a risk of dengue virus infection. However, the prognosis for the pregnant women infected with dengue remains unknown. There might be two explanations. One explanation is that dengue infection is aggravated in pregnant women. Adam et al. reported that, among 30 pregnant women infected by dengue virus, approximately 38.3% of them developed dengue hemorrhagic fever or dengue shock syndrome, and the mortality could reach 21.7% [10]. Machado (...truncated)


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Hao Zhang, Zhiyi He, Wenting Zeng, Hong-Juan Peng. Roles of Interferons in Pregnant Women with Dengue Infection: Protective or Dangerous Factors, Canadian Journal of Infectious Diseases and Medical Microbiology, 2017, 2017, DOI: 10.1155/2017/1671607