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Unique Impacts of HBV Co-infection on Clinical and Laboratory Findings in a Recent Dengue Outbreak in China

Yangbo Tang, Zhihua Kou, Xiaoping Tang^*, Fuchun Zhang, Xian Yao, Shengyong Liu, AND Xia Jin^*

High prevalence of hepatitis B virus (HBV) infection in China offers a unique setting to examine HBV’s influence on the presentation of dengue fever. In 398 patients admitted for suspected dengue fever, 89% (353/398) were positive for dengue IgM antibodies. Among dengue-infected patients, 8% (29/353) had chronic HBV co-infection. Only dengue virus serotype 1 was identified by virus isolation and reverse transcriptase-polymerase chain reaction assays. No case of dengue hemorrhagic fever/dengue shock syndrome was diagnosed. In addition to routine clinical tests, inter-leukin 2 (IL-2), IL-4, IL-6, IL-10, interferon (IFN), and tumor necrosis factor (TNF) levels were measured in the sera of 95% (334/353) of dengue-infected subjects as well as controls. Surprisingly, HBV/dengue co-infected patients made less IL-6 (P < 0.05) and TNF (P < 0.05) than patients with only dengue infection. Similar levels of IL-4, IL-10, and IFN were found in both groups. Thus, HBV co-infection seems to alter the cytokine production pattern when patients contract dengue infection.

Received October 17, 2007. Accepted for publication April 10, 2008.

Acknowledgments: The authors thank Maria Arevalo for editorial assistance.

Financial support: This study was supported by intramural research grants provided by the Guangzhou 8th People’s Hospital.

^* Address correspondence to Xiaoping Tang, Guangzhou 8th People’s Hospital, Guangzhou 510060, China, E-mail: xtang{at}21cn.com or Xia Jin, Department of Medicine, Infectious Diseases Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 689, Room 3-5103, Rochester, NY 14642. E-mail: xia_jin{at}urmc.rochester.edu

These authors contributed equally to this paper.

Authors’ addresses: Yangbo Tang, Guangzhou 8th People’s Hospital, Guangzhou 510060, China, Tel: 0086-20-83710937, Fax: 0086-20-83866127. Zhihua Kou, Department of Medicine, Infectious Diseases Division University of Rochester, 601 Elmwood Avenue, Box 689, Rochester, NY 14642, Tel: 585-275-3924, Fax: 585-442-9328. Xiaoping Tang, Departments of Laboratory Medicine, Guangzhou 8th People’s Hospital, Guangzhou 510060, China, Tel: 0086-20-83710688, Fax: 0086-20-83828442. Fuchun Zhang, Guangzhou 8th People’s Hospital, Guangzhou 510060, China, Tel: 0086-20-83710912, Fax: 0086-20-83828422. Xian Yao, Guangzhou 8th People’s Hospital, Guangzhou 510060, China, Tel: 0086-20-83710851, Fax: 0086-20-83866127. Shengyong Liu, Department of Medicine, Infectious Diseases Division University of Rochester, 601 Elmwood Avenue, Box 689, Rochester, NY 14642, Tel: 585-275-3924, Fax: 585-442-9328. Xia Jin, Department of Medicine, Infectious Diseases Division, University of Rochester, 601 Elmwood Avenue, Box 689, Room 3-5103, Rochester, NY 14642, Tel: 585-275-6515, Fax: 585-442-9328.

Reprints requests: Xiaoping Tang, Departments of Laboratory Medicine, Guangzhou 8th People’s Hospital, Guangzhou 510060, China, E-mail: xtang{at}21cn.com.