Influência do diabetes mellitus na infecção aguda por dengue durante epidemia de 2019 em São José do Rio Preto, SP

Abstract

ABSTRACT Introduction: Dengue has been an ongoing public health problem since its initial outbreak in the 1950s, and this has recorded a significant global increase in incidence and mortality rates over the last three decades. While dengue typically presents as a self-limiting febrile illness, some cases can progress to severe and life-threatening forms, particularly in cases of secondary heterologous infections. Recent research has explored additional risk factors over secondary infections, including underlying health conditions, even in individuals without prior exposure to dengue, notably, such ones associated with endothelial dysfunction and chronic inflammation. Objective: This study examines the link between diabetes and the development of severe dengue in dengue-naive patients during a 2019 outbreak, pointing out the role of diabetes as a risk factor for dengue severity. Material and Methods: This crosssectional study was based on data obtained from computerized medical records and disease notification forms for patients with confirmed dengue enrolled in hospital cohort of acute febrile cases between December 2018 and November 2019, in São José do Rio Preto, SP, Brazil. We enrolled 769 laboratoryconfirmed dengue cases, identified through DENV RT-PCR or NS1 antigen testing. Subsequently, we investigated the presence of anti-dengue and anti- Zika IgG antibodies to examine the history of these two infections. After laboratory analyses, three groups were delineated: naive/control, Zika history, and dengue history. Samples testing positive for both dengue and Zika were excluded from the analyses from the beginning. Results: Initially, age over 59 years, diabetes, high blood pressure, renal disease, peptic disease, as well as being dengue-naive, were associated with a higher frequency of severe and potentially severe cases. Binary logistic regression univariate analysis identified age over 59 years, diabetes, renal disease, peptic disease, and high blood pressure, along with the presence of anti-Zika IgG antibodies, as risk factors, while the presence of anti-dengue antibodies was considered protective. When we analyzed exclusively naïve-samples, diabetes highlighted as independent risk factor to severe forms of dengue. Conclusions: In this study, we investigated diabetes as an independent risk factor for severe dengue in individuals with no previous exposure to dengue or Zika. This finding is troubling in view of the global prevalence of diabetes and its potential impact even in those without prior exposure to dengue. Recognizing these risk factors is crucial for developing effective treatment strategies to reduce the morbidity and mortality associated with the coexistence of these diseases.