Atypical lymphocyte count correlates with the severity of dengue infection

• Published in: PloS one 2019-05, Vol.14 (5), p.e0215061-e0215061
• Main Authors: Clarice, Choong Shi Hui, Abeysuriya, Visula, de Mel, Sanjay, Uvindu Thilakawardana, Basuru, de Mel, Primesh, de Mel, Chandima, Chandrasena, Lal, Seneviratne, Suranjith L, Yip, Christina, Yap, Eng Soo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Antibodies; Antigens; Automation; B cells; Biology and Life Sciences; Bleeding; Blood; Blood tests; Cancer; Cell number; Complications; Correlation analysis; Dengue; Dengue fever; Dengue hemorrhagic fever; Education; Enzymes; Female; Health risks; Hematology; Hospitals; Humans; Hypotension; Hypotension - epidemiology; Hypotension - etiology; Immunoglobulin M; Immunoglobulins; Infection; Infections; Laboratories; Laboratory tests; Longitudinal studies; Lymphocyte Count; Lymphocytes; Male; Medical records; Medicine and Health Sciences; Middle Aged; Oncology; Patients; Prospective Studies; Research and Analysis Methods; Severe Dengue - complications; Severe Dengue - immunology; Severity of Illness Index; Shock; Systematic review; Tropical diseases; Vector-borne diseases; Viral infections; White blood cell count; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0215061

The early identification of patients at risk of severe dengue infection (DI) is critical to guide clinical management. There is currently no validated laboratory test which can predict severe complications of DI. The Atypical lymphocyte count (ALC) is a research parameter generated at no extra cost when an automated Full Blood Count (FBC) is performed. The purpose of this study was to assess the association of ALC with the severity of DI. We prospectively collected data on patients admitted to Nawaloka Hospital Sri Lanka (NH) with DI between December 2016 and November 2017. DI was diagnosed based on a positive Non-structural antigen 1 (NS1) or dengue IgM antibody. ALC (absolute ALC and percentage) data were extracted from the Sysmex XS500i automated full blood count (FBC) analyzer (Sysmex Corporation Kobe, Japan). Clinical data was recorded from medical records and the computerized data base maintained by NH. 530 patients were enrolled. Patients with clinical manifestations of severe dengue have a significantly higher AL % compared to dengue without warning signs. Patients who presented with respiratory compromise had statistically significantly higher AL% compared to those without. (AL%; 8.65±12.09 vs 2.17±4.25 [p = 0.01]). Similarly, patients who developed hypotension had higher AL% compared to those who did not suffered from shock (AL%; 8.40±1.26 vs 2.18±4.25 [p = 0.001]). The AL% of dengue patients presenting with bleeding, at 4.07%, is also higher than those without bleeding complications, at 2.15%. There was a significant negative association between platelet count and AL% (p = 0.04). Clinical manifestations of severe dengue have a significantly higher AL % compared to dengue without warning signs. AL % at presentation may be predictive of severe DI and future larger prospective longitudinal studies should be done to determine if AL % on admission is predictive of the complications of DI.