title: A re-evaluation of the mechanisms leading to dengue hemorrhagic fever.
abstract: Viremia is one of the features of dengue virus infection among the flaviviruses. Dengue virus infection results in a spectrum of clinical symptoms, ranging from undifferentiated flu-like illness, mild dengue fever, to dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), a life-threatening illness. Several mechanisms have been hypothesized based primarily on data collected from post-acute clinical phase to account for DHF/DSS. Lack of a suitable animal model for DHF/DSS has hindered progress in defining the etiology of DHF/DSS. Levels of circulating dengue virus have been well-correlated to severe dengue disease. However, the cell lineage(s) serving as a primary target for the source of viremia are largely unknown. Results from in vivo and in vitro pilot studies using molecular and more advanced technologies reveal that dengue virus appears to be associated with platelets and the megakaryocytic lineage. The observation may partially explain the dysfunction of platelets observed in dengue affected patients.
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Sansanee
authors.initials: S
authors.lastname: Noisakran
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
authors.forename: Pucharee
authors.initials: P
authors.lastname: Songprakhon
authors.forename: Nattawat
authors.initials: N
authors.lastname: Onlamoon
authors.forename: Hui-Mien
authors.initials: HM
authors.lastname: Hsiao
authors.forename: Francois
authors.initials: F
authors.lastname: Villinger
authors.forename: Aftab
authors.initials: A
authors.lastname: Ansari
authors.forename: Guey Chuen
authors.initials: GC
authors.lastname: Perng
mesh_terms: D001792:Blood Platelets / Q000502:physiology / Q000821:virology; D002980:Climate; D003716:Dengue Virus / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity; D017752:Greenhouse Effect; D006801:Humans; D007113:Immunity, Innate; D011634:Public Health; D012328:RNA Viruses / Q000472:pathogenicity; D019595:Severe Dengue / Q000097:blood / Q000453:epidemiology / Q000276:immunology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology; D014766:Viremia / Q000276:immunology / Q000503:physiopathology