Correlation between detection of plasminogen cross-reactive antibodies and hemorrhage in dengue virus infection

Although dengue fever (DF) is usually self-limited, some patients experience severe and prolonged illness characterized by capillary leakage, which may progress to hypovolemic shock (dengue hemorrhagic fever/dengue shock syndrome; DHF/DSS) with hemorrhage of unknown etiology. Development of antibodies potentially cross-reactive to plasminogen has been reported in a high percentage of Thai patients with DF and DHF/DSS. Correlation between detection of plasminogen cross-reactive antibodies and hemorrhage was evaluated in 88 Tahitian children with dengue virus type 3 infection who presented with (n = 59) or without (n = 29) hemorrhage. Plasminogen cross-reactive antibodies were found in acute and convalescent sera of 33 and 11 children, respectively (56% vs. 31%, P < .05), and closely paralleled antibodies to the cross-reactive site in dengue virus E protein. Antibodies were more frequent in children with secondary than primary infections (60% vs. 32%, P < .05). Plasminogen cross-reactive antibodies did not correlate with occurrence of DHF/DSS or thrombocytopenia. These results are consistent with the possibility that plasminogen cross-reactive antibodies play a role in the etiology of hemorrhage in dengue virus infection.