Serum zinc levels and clinical severity of dengue infection in children
Keywords:
serum zinc levels, dengue infection, clinical severity
Abstract
Background Immunopathogenesis of dengue infection revealsthe aberrant immune response. Zinc deficiency alters immune
response and therefore may associated with clinical severity of
dengue infection.
Objective To indentifY the relationship between serum zinc levels and clinical severity of dengue infection in children.
Methods A comparative study was conducted at the Department
of Child Health Hasan Sadikin Hospital Bandung, from February
to March 2007. We included children aged ~ 14 years fulfilled the
clinical criteria for dengue fever (OF), dengue hemorrhagic fever
(DHF), and dengue shock syndrome (DSS) according to WHO
(1997), confirmed with serologic test. Subjects were selected
consecutively until met the sample size for each group. Serum
zinc level were measured with atomic absorption spectroscopy
(MS) on admission. Data were analyzed using Kruskal-Wallis and
Pearson chi square test. Significance was considered if P<0.05.
Results The serum zinc levels were low in 47 (78.3%) children.
The serum zinc level in OF, DHF, and DSS subjects were 56-81 (X
±SO= 68.2±8.3) J.Lg/dL; 50-77 (X± SO = 61.6 ± 8. 7) J.Lg/dL;
and35-52 (X± SO= 42.7 ± 5.4) j.tg/dL, respectively (P<0.001).
The prevalence ratio ofDF to DHF and DHF to DSS were 1.444
(P=0.311) and 3.353 (P=0.077), respectively.
Conclusion Low serum zinc level were significantly different in
each clinical severity of dengue infection. However, low serum zinc level was not a risk factor for the development of severe dengue infection in children.
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2. Thongcharoen P, Jatanasen S. Epidemiology of dengue and
dengue haemorrhagic fever. In: Thongcharoen P, editor.
Monograph on dengue/dengue haemorrhagic fever. Regional
Publication, SEARO No. 22, 1993. p. 1-8.
3. Malavige ON, Fernando S, Seneviratne SL. Dengue viral
infections. Postgrad Med J. 2004;80:588-601.
4. World Health Organization. Dengue, dengue haemorrhagic
fever and dengue shock syndrome in the context of the
integrated management of childhood illness. Geneva: World
Health Organization; 2005.
5. Hadinegoro SR, Purwanto SH, Chatab F. DSS: clinical
manifestation, management and outcome. A hospital based
study in Jakarta, Indonesia. Dengue Bull. 1999;23: 12.
6. Rothman AL. Dengue: defining protective versus pathologic
immunity. J Clin Invest. 2004; 113:946-51.
7. Halstead SB. Antibody, macrophages, dengue virus infection,
shock, and hemorrhage: A pathogenic cascade. Rev Infect
Dis. 1989; 11 (suppl4):S830-9
8. Kurane I, Rothman AL, Livingston PO. Immunopathologic
mechanisms of dengue hemorrhagic fever and dengue shock
syndrome. Arch Viral. 1994;9:59-64.
9. Mongkolsapaya J, Dejnirattisai W, Xu XN, Vasanawathana
S, Tangthawornchaikul N, Chairunsri A, et al. Original
antigenic sin and apoptosis in the pathogenesis of dengue
hemorrhagic fever. Nature Med. 2003;9:921-7.
10. Lei HY, Huang KJ, Lin YS, Yeh TM, Liu HS, Liu CC.
lmmunopathogenesis of dengue hemorrhagic fever. Am J
Infect Dis. 2008;4(1):1-9.
11. Widagdo. Blood zinc levels and clinical severity of dengue
hemorrhagic fever in children. Southeast Asian J Trop Med
Pub Health. 2008;39(4):610-6.
12. Black RE. Zinc deficiency, infectious disease and mortality
in the developing country. J Nutr. 2003;133:S1485-9.
13. Fischer WC, Black RE. Zinc and the risk for infectious disease.
Annu Rev Nutr. 2004;24:255-75.
14. Shankar AH, Prasad AS. Zinc and immune function: the
biological basis of altered resistance to infection. Am J Clin
Nutr. 1998;68:447-63.
15. Hung NT, Lan NT, Lei HY, Lin YS, Lien LB. Association
between sex, nutritional status, severity of dengue
hemorrhagic fever, and immune status in infants
with dengue hemorrhagic fever. Am J Trop Med Hyg.
2005;72:370-4.
16. Taweepong T, Supapan T. Risk factors of dengue shock
syndrome in children. J Med Assoc Thai. 2007;90:272-7.
17. Hammond SN, Balmaseda A, Perez L, Tellez Y, Saborio SI.
Differences in dengue severity in infants, children, and adults
in a 3-years hospital-base study in Nicaragua. AmJ Trop Med
Hyg. 2006;73:1063-70.
18. Junia J, Garna H, Setiabudi D. Clinical risk factors for
dengue shock syndrome in children. Paediatr lndones.
2007;4 7:7-11.
19. Thisyakorn U, Nimmannitya S. Nutritional status of
children with dengue hemorrhagic fever. Clin Infect Dis.
1993;16:295-7.
20. Narayanan M, Arafind MA, Thilothammal N, Prema R,
Sargunam CSR, Ramamurty N. Dengue fever epidemic in
Chennai-A study of clinical profile and outcome. Indian
Pediatr. 2002;39:1027-33.
21. Tantracheewathorn T, Tantracheewathorn S. Risk factors
of dengue syok syndrome in children. J Med Assoc Thai.
2007;90(2):272-7.
22. Vaughn DW, GreenS, Kalayanarooj S, Innis BL, Nimmannitya
S, Suntayakhon S, et al. Dengue viremia titer, antibody
response pattern, and virus serotype correlate with disease
severity. JID. 2005;181:2-9.
23. King LE, Fraker PJ. Variations in the cell cycle status
of lymphopoietic and myelopoietic cells created by zinc
deficiency. J Infect Dis. 2000;182(Suppll):S16-22.
24. King LE, Fraker PJ. Zinc deficiency in mice alters myelopoiesis
and hematopoiesis. J Nutr. 2002; 132:3301-7.
25. Prasad AS. Discovery of human zinc deficiency of zinc.
In: Tomita H, editor. Trace elements in clinical medicine.
Tokyo:Springer-Verlag, 1999; p.3-11
26. Berger A. What does zinc do? BMJ. 2002;325: 1062-3.
Published
2009-12-31
How to Cite
1.
Yuliana N, Fadil R, Chairulfatah A. Serum zinc levels and clinical severity of dengue infection in children. PI [Internet]. 31Dec.2009 [cited 19Apr.2024];49(6):309-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/589
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Received 2016-09-11
Accepted 2016-09-11
Published 2009-12-31
Accepted 2016-09-11
Published 2009-12-31
