The dengue virus (DENV) has been endemic in Myanmar since 1970, causing outbreaks every 2-3 years. DENV
infection symptoms range from mild
fever to lethal
hemorrhage. Clinical
biomarkers must be identified to facilitate patient risk stratification in the early stages of
infection. We analyzed 45
cytokines and other factors in serum samples from the acute phase of DENV
infection (within 3-5 days of symptom onset) from 167 patients in Yangon, Myanmar, between 2017 and 2019. All of the patients tested positive for serum DENV nonstructural
protein 1
antigen (NS1 Ag); 78.4% and 62.9% were positive for
immunoglobulin M (
IgM) and G (
IgG), respectively; and 18.0%, 19.8%, and 11.9% tested positive for serotypes 1, 3, and 4, respectively. Although the DENV-4 viral load was significantly higher than those of DENV-1 or DENV-3, disease severity was not associated with viral load or serotype. Significant correlations were identified between disease severity and CCL5, SCF,
PDGF-BB,
IL-10, and TNF-α levels; between NS1 Ag and SCF, CCL5, IFN-α, IL-1α, and
IL-22 levels; between
thrombocytopenia and
IL-2, TNF-α,
VEGF-D, and
IL-6 levels; and between primary or
secondary infection and
IL-2,
IL-6, IL-31, IL-12p70, and MIP-1β levels. These circulating factors may represent leading signatures in acute DENV
infections, reflecting the clinical outcomes in the
dengue endemic region, Myanmar.