title: Cytokine cascade in dengue hemorrhagic fever: implications for pathogenesis.
abstract: Dengue virus produces a mild acute febrile illness, dengue fever (DF) and a severe illness, dengue hemorrhagic fever (DHF). The characteristic feature of DHF is increased capillary permeability leading to extensive plasma leakage in serous cavities resulting in shock. The pathogenesis of DHF is not fully understood. This paper presents a cascade of cytokines, that in our view, may lead to DHF. The main feature is the early generation of a unique cytokine, human cytotoxic factor (hCF) that initiates a series of events leading to a shift from Th1-type response in mild illness to a Th2-type response resulting in severe DHF. The shift from Th1 to Th2 is regulated by the relative levels of interferon-gamma and interleukin (IL)-10 and between IL-12 and transforming growth factor-beta, which showed an inverse relationship in patients with DF.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait. chaturvedi@hsc.kuniv.edu.kw
authors.forename: U C
authors.initials: UC
authors.lastname: Chaturvedi
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
authors.forename: E A
authors.initials: EA
authors.lastname: Elbishbishi
authors.forename: A S
authors.initials: AS
authors.lastname: Mustafa
mesh_terms: D000818:Animals; D016207:Cytokines / Q000378:metabolism*; D003716:Dengue Virus / Q000472:pathogenicity*; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D018664:Interleukin-12 / Q000378:metabolism; D007378:Interleukins / Q000378:metabolism; D008264:Macrophages / Q000276:immunology; D019595:Severe Dengue / Q000276:immunology* / Q000821:virology; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D015291:Transforming Growth Factors / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D016207:Cytokines; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D018664:Interleukin-12; D015291:Transforming Growth Factors; D007371:Interferon-gamma