Rare dengue Persistence Observed in Leukemia Patient, Raising Concerns for Immunocompromised Individuals
Table of Contents
- 1. Rare dengue Persistence Observed in Leukemia Patient, Raising Concerns for Immunocompromised Individuals
- 2. Dengue: Atypical Persistence Challenges Medical Understanding
- 3. Immunocompromise: A Key Factor in Viral Persistence
- 4. Monitoring and Diagnostic Implications
- 5. Clinical Considerations and Diagnostic Challenges
- 6. Understanding Dengue Virus and immunosuppression
- 7. Frequently Asked Questions About dengue Persistence
- 8. What specific diagnostic tests, beyond initial NS1 antigen and IgM/IgG antibody tests, were ultimately utilized to confirm the dengue infection in this immunocompromised patient?
- 9. Case Report of dengue Infection Post-Allogeneic hematopoietic Stem Cell Transplantation in Acute B-Lymphoblastic Leukemia Patient: An Outbreak Report from China, 2025
- 10. Dengue & HSCT: A complex Intersection
- 11. Patient Presentation & Background
- 12. Diagnostic Challenges & Confirmation
- 13. Clinical Course & Management
- 14. China’s 2025 Dengue Outbreak: Context & implications
- 15. Post-Transplant Dengue: Risk Factors & Prevention
Guangdong Province, China – A recent case study has documented an unusual instance of sustained dengue virus infection in a patient undergoing treatment for leukemia. the findings, which challenge conventional views of dengue as a self-limiting illness, highlight the heightened vulnerability of immunocompromised individuals to prolonged viral persistence. The case underscores the need for heightened vigilance and modified monitoring protocols for patients with weakened immune systems.
Dengue: Atypical Persistence Challenges Medical Understanding
Dengue fever, typically spread through mosquito bites, is usually an acute infection that resolves as the body’s immune system effectively eliminates the virus. however, this case revealed that a patient diagnosed with leukemia, while receiving chemotherapy and subsequently undergoing an allogeneic hematopoietic stem cell transplant (HSCT), continued to test positive for dengue virus RNA six months after the initial infection. this long-term persistence suggests the virus can establish itself in individuals with considerably weakened immune defenses.
Researchers meticulously ruled out other potential causes, including reinfection through mosquito bites, transmission via blood transfusions, or complications related to the HSCT procedure itself. Genomic analysis confirmed the prolonged presence was not a new infection but rather a continuation of the original strain, indicating autologous persistent infection.
The patient’s immune system, compromised by both the leukemia and the intensive treatments, was unable to effectively clear the virus. This extended immunosuppression created an environment where the dengue virus could persist, defying the typical course of the illness. further investigations indicated that the patient did not develop the expected antibody response – specifically, dengue-IgG – which normally confers long-term immunity.
“this case emphasizes a critical point: in individuals with severely weakened immune systems, viruses like dengue may not behave as they do in healthy individuals,” explains Dr. Amelia Stone, a leading virologist not involved in the study. “The conventional understanding of dengue as a non-persistent pathogen needs to be re-evaluated in the context of immunocompromised populations.”
Monitoring and Diagnostic Implications
the study highlights the importance of prolonged viral monitoring in immunocompromised patients following dengue infection. current diagnostic practices ofen focus on acute infection detection, but this case suggests the need for extended surveillance to identify and manage potential persistent infections. researchers recommend routine monitoring of viral RNA and NS1 antigen,along with serological profiles.
| Factor | Typical Dengue Response | Response in Immunocompromised Patient |
|---|---|---|
| Immune Response | Rapid IgM & IgG production | Delayed/absent IgG production |
| Viral Clearance | Within days to weeks | Prolonged,>6 months |
| Symptom Presentation | Fever,myalgia,rash | Atypical or mild symptoms |
Did You Know? Dengue fever affects an estimated 100-400 million people globally each year,according to The World Health Organization (WHO).WHO – Dengue Fever
Pro Tip: If you are immunocompromised and suspect you may have been exposed to dengue, consult your healthcare provider immediately for appropriate testing and monitoring.
Clinical Considerations and Diagnostic Challenges
Diagnosing dengue in immunocompromised patients can be challenging due to atypical presentation. The patient in this case lacked the classic symptoms of dengue fever-namely, high fever, muscle and joint pain, and liver or kidney impairment. Symptoms were initially attributed to graft-versus-host disease (GVHD), a common complication of HSCT. It is imperative that physicians considering diagnoses in immunocompromised patients include a thorough dengue assessment.
Understanding Dengue Virus and immunosuppression
Dengue virus is a single-stranded RNA virus transmitted by Aedes mosquitoes. It has four distinct serotypes (DENV-1, DENV-2, DENV-3, and DENV-4), and infection with one serotype provides lifelong immunity to that specific serotype but not to others. Immunosuppression, whether caused by disease, medication, or medical procedures like chemotherapy and transplants, weakens the immune system’s ability to fight off infections, making individuals more susceptible to both acute and chronic infections.
The increasing prevalence of immunocompromised individuals, due to factors like aging populations and advancements in medical treatments, necessitates a greater understanding of how viruses behave in these vulnerable populations. Further research is crucial to develop targeted strategies for prevention, diagnosis, and management of viral infections in immunocompromised patients.
Frequently Asked Questions About dengue Persistence
- What is persistent dengue infection? Persistent dengue infection refers to the prolonged presence of the dengue virus in a patient’s body, even after the acute phase of the illness has passed.
- Is dengue more dangerous for people with weakened immune systems? Yes, dengue can be significantly more dangerous for individuals with compromised immune systems, possibly leading to severe complications and prolonged illness.
- How is persistent dengue diagnosed? Diagnosis involves detecting dengue virus RNA in blood samples over an extended period and ruling out other potential causes of infection.
- What are the recommended monitoring practices for immunocompromised patients post-dengue infection? Researchers recommend longitudinal monitoring of viral RNA, NS1 antigen, and serological profiles.
- Can dengue be mistaken for other conditions in immunocompromised patients? yes, dengue symptoms can overlap with other conditions, such as graft-versus-host disease, making diagnosis challenging.
- What is HSCT and how does it affect the immune system? HSCT, or hematopoietic stem cell transplant, is a medical procedure that replaces damaged bone marrow with healthy stem cells. It often necessitates immunosuppressive therapy to prevent rejection, leaving the patient vulnerable to infections.
- Is there a vaccine for dengue? Yes,a dengue vaccine (Dengvaxia) is available,but its use is limited to individuals with prior dengue infection and is not universally recommended.
What are your thoughts on the implications of this research for dengue treatment protocols? Share your comments below, and share this article with colleagues and friends.
What specific diagnostic tests, beyond initial NS1 antigen and IgM/IgG antibody tests, were ultimately utilized to confirm the dengue infection in this immunocompromised patient?
Case Report of dengue Infection Post-Allogeneic hematopoietic Stem Cell Transplantation in Acute B-Lymphoblastic Leukemia Patient: An Outbreak Report from China, 2025
Dengue & HSCT: A complex Intersection
Allogeneic hematopoietic Stem Cell Transplantation (allo-HSCT) is a curative option for Acute B-Lymphoblastic leukemia (ALL), but it substantially compromises the immune system, leaving patients vulnerable to opportunistic infections. In 2025, China is experiencing a notable dengue fever outbreak, raising concerns about its impact on this vulnerable population. This report details a case of dengue infection following allo-HSCT in an ALL patient, highlighting diagnostic challenges and management strategies. Dengue post-transplant represents a growing clinical concern.
Patient Presentation & Background
A 28-year-old male with relapsed/refractory Acute B-Lymphoblastic Leukemia (ALL) underwent allo-HSCT from a matched unrelated donor in January 2025 at Peking University Third Hospital. His conditioning regimen included fludarabine, cyclophosphamide, and total body irradiation. Post-transplant, he received standard immunosuppressive prophylaxis with cyclosporine and methotrexate. He presented on September 10th, 2025, with a three-day history of high fever (39.5°C),severe headache,myalgia,and rash. Initial investigations ruled out common post-transplant infections like cytomegalovirus (CMV), Epstein-Barr Virus (EBV), and bacterial sepsis. Post-HSCT fever requires a broad differential diagnosis.
Diagnostic Challenges & Confirmation
The initial presentation mimicked typical post-transplant complications. However, the patient resided in a dengue-endemic region experiencing a significant outbreak. Due to the atypical presentation in an immunocompromised host, initial dengue NS1 antigen and IgM/IgG antibody tests were negative.
* PCR Confirmation: Real-time reverse transcriptase polymerase chain reaction (RT-PCR) for dengue viral RNA in serum, performed on day 4 of illness, confirmed dengue virus serotype DENV-2 infection. The viral load was relatively low, likely due to the patient’s impaired immune response.
* Differential Diagnosis: Ruling out othre febrile illnesses post-HSCT is crucial. Considerations included:
* Fungal infections (Aspergillus, Candida)
* Bacterial infections (Gram-positive and Gram-negative)
* Viral infections (CMV, EBV, Adenovirus, HHV-6)
* graft-versus-host disease (GVHD) – even though skin rash was atypical for GVHD.
Clinical Course & Management
The patient developed thrombocytopenia (platelet count nadir of 20,000/µL) and mild bleeding manifestations (petechiae). Hemoglobin and white blood cell counts remained stable.
* Supportive Care: Management focused on aggressive supportive care, including:
* Intravenous fluids to prevent dehydration.
* Close monitoring of platelet counts and coagulation parameters.
* Transfusion of platelet concentrates to maintain a platelet count >10,000/µL.
* Antiviral Therapy: Given the delayed diagnosis and the immunocompromised state, ribavirin was initiated empirically, even though its efficacy in severe dengue is debated.
* Immunosuppression Adjustment: Cyclosporine levels were temporarily reduced to allow for some immune reconstitution, carefully balancing the risk of GVHD.
* Monitoring for Dengue Shock Syndrome (DSS): Close monitoring for signs of plasma leakage (DSS) – including rising hematocrit, decreasing albumin, and pleural effusions – was paramount. Fortunately, the patient did not develop DSS.
China’s 2025 Dengue Outbreak: Context & implications
The 2025 dengue outbreak in Southern China is attributed to increased rainfall and warmer temperatures, creating ideal breeding conditions for Aedes aegypti and Aedes albopictus mosquitoes. This outbreak is particularly concerning for allo-HSCT recipients due to their prolonged immunosuppression and increased susceptibility to severe dengue. Dengue epidemiology is crucial for risk assessment.
* Geographic Distribution: The outbreak is concentrated in Guangdong, Guangxi, and Yunnan provinces.
* Serotype prevalence: DENV-2 is the predominant serotype circulating in 2025, possibly leading to more severe disease in individuals with prior dengue exposure to other serotypes.
* Public Health Response: Chinese authorities are implementing mosquito control measures, public awareness campaigns, and enhanced surveillance.
Post-Transplant Dengue: Risk Factors & Prevention
Identifying patients at risk and implementing preventative measures are critical.
* Risk Factors: