Gut Leakage' in Dengue (GLiD)

Gut Leakage and Sonographic Abdominal Changes in Hospitalized Dengue Patients: an Observational Study

Dengue infections are imposing an increasing global burden of disease, particularly in tropical countries such as Bangladesh. The World Health Organization (WHO) has identified Dengue virus as a priority pathogen for the development of medical counter measures because of the high risk of it causing a Public Health Emergency of Intenational Concern (PHEIC). Warning signs for severe dengue, associated with mortality, include gastrointestinal features including abdominal pain, vomiting, and diarrhoea. Multiple alterations may occur in in the gastrointestinal tract that could lead to damaging of the gastrointestinal wall and gut leakage, the translocation of gut metabolites into the bloodstream. We hypothesize that gut leakage initiates inflammatory processes underlying the further development of severe dengue, including features associated with plasma leakage.

This study aims to investigate intestinal barrier dysfunction (gut leakage) in dengue infection by detecting the translocation of gut-derived bacteria and their products (Lipopolysaccharides, LPS binding protein, sCD14, I-Fatty Acid Binding Protein) into the bloodstream. We will recruit hospitalized adult dengue patients (18 years and older) presenting with warning signs or severe disease in a tertiary care public hospital at Chattogram, Bangladesh. Circulating biomarkers indicative of gut permeability and microbial translocation will be measured to assess their presence and association with disease severity.

Abdominal ultrasonography will be performed to characterize gastrointestinal alterations and determine their correlation with biochemical markers of gut leakage and clinical severity. In addition, we will analyze the gut bacteriome from stool/ rectal swab of these patients to explore whether dengue infection induces compositional changes in intestinal microbiota and whether such alterations are linked to gut leakage or disease progression.

Study Overview

• Status: Not yet recruiting
• Conditions: Ascites; Dengue; Dengue Hemorrhagic Fever; Intestinal Disease; Gut Microbiome; Dengue With Warning Signs

• Study Type: Observational
• Enrollment (Estimated): 190

Contacts and Locations

Study Locations

• Bangladesh
  • Chattogram Division
    • Chittagong, Chattogram Division, Bangladesh, 4203
      • Department of Medicine, Chittagong Medical College
      • Contact: Rabiul Alam Md Erfan Uddin, FCPS; Phone Number: +8801711129798; Email: rubelerfan@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Adult (≥18 years) male and non-pregnant female patients with confirmed dengue (positive NS1 antigen and/or IgM) admitted to the Department of Medicine, Chittagong Medical College Hospital will be recruited. Blood biomarkers will be collected at enrollment for all patients. Those initially classified as non-severe dengue will have no repeat sampling unless they progress to severe disease, in which case a second sample will be obtained within 24 hours. Serum ALT and blood culture will be performed on day 7 of illness. Stool samples will be collected on day 7 from 100 patients for gut microbiota analysis.

Additionally, 10 healthy adult participants (5 male, 5 female) will be recruited from patient attendants. They will undergo a single visit for baseline biomarker sampling and POCUS, serving as healthy controls for comparison.

Description

Inclusion Criteria:

Dengue participants

• Participant/ legally authorised representative willing and able to give informed consent for participation in the study.
• Male or Female, adults ≥18 years
• Diagnosed as a case of Dengue on the basis of clinical features and positive NS1 antigen and/or IgM dengue antibody
• Hospitalized in medicine or dengue ward in Chittagong Medical College Hospital.
• Enrolled within 24 hours of hospitalization.

Healthy participants

• Participant/ legally authorised representative willing and able to give informed consent for participation in the study.
• Male or Female, adults ≥18 years
• Clinically healthy with no acute or chronic illness
• Attendant of a dengue patient (not a patient)

Exclusion Criteria:

Dengue participants

• Unable to provide consent or participate in follow-up procedures
• Known chronic gastrointestinal (GI) disease affecting intestinal permeability (IBD, celiac disease), chronic liver disease, active chronic diarrhoea, short bowel loop syndrome, recent (<3 months) major GI surgery.
• Immunosuppression (for example chemotherapy, high-dose steroids), advanced chronic kidney disease, decompensated heart failure.
• Drugs that can alter the level of biomarkers in blood like metformin, statin, probiotics, steroid within last 48 hours of hospitalization.
• Pregnancy

Healthy participants

• Unable to provide consent
• Known chronic gastrointestinal (GI) disease affecting intestinal permeability (IBD, celiac disease), chronic liver disease, active chronic diarrhoea, short bowel loop syndrome, recent (<3 months) major GI surgery.
• Immunosuppression (for example chemotherapy, high-dose steroids), advanced chronic kidney disease, decompensated heart failure.
• Drugs that can alter the level of biomarkers in blood like metformin, statin, probiotics, steroid within last 48 hours of hospitalization.
• Pregnancy
• History of current or recent dengue or other arbo viral infection

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Severe dengue; All enrolled dengue patients will have blood biomarkers at enrolment whether they present with non-severe or severe dengue. If participant enrolled as non-severe and do not progress to severe dengue, they will be no second test for biomarkers but if they developed clinical feature of severity, a second biomarker sample will be collected within 24 hours of developing clinical severity. S ALT and Blood culture will be performed on day 7 of illness for all dengue patients. Stool will be collected on day 7 of illness from 100 patients for testing gut microbiota.
Non-severe dengue; All enrolled dengue patients will have blood biomarkers at enrolment whether they present with non-severe or severe dengue. If participant enrolled as non-severe and do not progress to severe dengue, they will be no second test for biomarkers but if they developed clinical feature of severity, a second biomarker sample will be collected within 24 hours of developing clinical severity. S ALT and Blood culture will be performed on day 7 of illness for all dengue patients. Stool will be collected on day 7 of illness from 100 patients for testing gut microbiota.
Healthy individual; These participants will undergo only one study visit for baseline biomarker sampling, baseline POCUS and will not undergo follow-up. Their results will serve as healthy control reference values for comparison with biomarker findings in dengue patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Level of gut leakage marker in blood and gastrointestinal findings in POCUS	On enrollment, day of development of severity if non severe at enrolment, up to 28 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Document clinical events occurred in dengue patients	Demographic: Age, gender, BMI Clinical: respiratory rate, blood pressure, heart rate, ascites, pleural effusion, any major bleeding, GCS	Through study completion, an average of 28 days
Document clinical events occurred in dengue patients	For mSOFA: SpO2, FiO2	Day of enrolment/ 4th or day 7 of illness

Other Outcome Measures

Outcome Measure	Time Frame
Level of I-FABP Level of LPS, Level of LBP, Level of sCD14, Positive Blood culture	On enrollment in all cases, if clinical severity occur in initial non-severe group, 24 hours within developing severity
Detectable fluid collection in abdomen, loss of haustration, loss of normal multi-layered appearance	Enrollment day, day of development of clinical severity
Measurement of gall bladder wall thickness, intestinal wall thickness	Enrollment day, day of development of clinical severity
Alteration of gut microbiota	Day seven of illness
Organ failure	Through study completion, an average of 28 day
Development of shock	Through study completion, an average of 28 day

Collaborators and Investigators

• Sponsor: University of Oxford

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): January 31, 2027
• Study Completion (Estimated): January 31, 2028

Study Registration Dates

• First Submitted: April 28, 2026
• First Submitted That Met QC Criteria: May 15, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 15, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Vector Borne Diseases; Mosquito-Borne Diseases; Pathologic Processes; Infections; RNA Virus Infections; Virus Diseases; Digestive System Diseases; Gastrointestinal Diseases; Arbovirus Infections; Flavivirus Infections; Flaviviridae Infections; Hemorrhagic Fevers, Viral; Pathological Conditions, Signs and Symptoms; Dengue; Intestinal Diseases; Ascites; Severe Dengue
• Other Study ID Numbers: VIR26001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Participant data and results from blood analyses stored in the database may be shared according to the terms defined in the MORU data sharing policy with other researchers to use in the future. Datasets will be de-identified to ensure patient privacy and confidentiality

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No