Dengue serotypes and their severity correlation: A hospital-based observational study

Abstract

Introduction: Dengue virus (DENV) infection can present a range of clinical manifestations, from mild fever to severe complications. Emerging data suggest that specific viral serotypes may influence disease severity. This study aimed to evaluate the circulating DENV serotypes and their correlation with clinical outcomes in hospitalized patients.

Methods: A retrospective, cross-sectional study was conducted at a tertiary care center in northern India from August 2022 to January 2023. Laboratory-confirmed dengue cases (N=356) were included, and serotyping was performed via nested reverse transcription-polymerase chain reaction (nested RT-PCR). Demographic, clinical, and biochemical data were analyzed. Statistical comparisons and relative risk analyses were performed to identify associations between serotypes and disease severity, including mortality predictors.

Results: Out of the 111 dengue cases, 7 had mixed serotypes. Among the remaining 104 patients, DENV-2 was the predominant serotype (71.2%), followed by DENV-3 (26.9%), DENV-1 (1.9%), and mixed serotypes (6.3%) infections. Overall, 71.2% of patients presented with warning signs, and 28.8% progressed to severe dengue. The highest severe dengue cases were observed in DENV-2 (33.8%) and in mixed DENV-2 & 3 infections (100%). DENV-2 was significantly associated with severe manifestations such as plasma leakage (RR=24.73, p<0.001), hemorrhagic rash, and elevated transaminases. Mortality (21.6%) occurred exclusively in DENV-2 and mixed DENV-2 and 3 infections. Predictors of mortality included thrombocytopenia, leucopenia, elevated SGPT/SGOT, and hypoalbuminemia.

Conclusion: DENV-2 is the principal serotype associated with severe dengue and adverse outcomes in this region. Early identification of serotype and key laboratory parameters can improve risk stratification and clinical management, with implications for surveillance and public health response.

Keywords: Atypical manifestations; Dengue grave; Exantemas; Hepatitis; Manifestaciones atípicas; Mortality predictors; Predictores de mortalidad; Rashes; Severe dengue; Thrombocytopenia; Trombocitopenia.