Viremia is one of the features of dengue virus infection among the flaviviruses. Dengue virus infection results in a spectrum
Key words: flavivirus; dengue virus; DHF; DSSDengue virus infection and dengue disease are recognized as a major public health issue internationally.1 Dengue virus infection is the most important mosquito borne human disease in terms of morbidity and mortality in urban tropical area. Climate changes, such as global warming and El Nino, poorly urbanization planning, an increase in international travel, and lack of effective vector-control programs, are the predominant cause of the expanAddress for correspondence: Guey Chuen Perng, Ph.D., Dental School Building, Room 429, 1462 Clifton Road, Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA 30322. Voice: 404-727-5490. gperng@emory.edu sion of dengue threat.2 The National Institute of Allergy and Infectious Diseases (NIAID) has listed dengue virus as a Category A priority biothreat pathogen.3 Over 100 million people living in tropical and subtropical areas are at risk of infection with the dengue virus. Estimated 50 million cases of dengue illness are documented per year globally. The death rate from dengue illness ranges from 2 to 5%, predominantly in children under 15 years of age.
Dengue has been recognized as one of the most important vector-borne emerging infectious diseases globally. Though dengue normally causes a self-limiting infection, some patients may develop a life-threatening illness, dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The reason why DHF/DSS occurs in certain individuals is unclear. Studies in the endemic regions suggest that the preexisting antibodies are a risk factor for DHF/DSS. Viremia and thrombocytopenia are the key clinical features of dengue virus infection in patients. The amounts of virus circulating in patients are highly correlated with severe dengue disease, DHF/DSS. Also, the disturbance, mainly a transient depression, of hematological cells is a critical clinical finding in acute dengue patients. However, the cells responsible for the dengue viremia are unresolved in spite of the intensive efforts been made. Dengue virus appears to replicate and proliferate in many adapted cell lines, but these in vitro properties are extremely difficult to be reproduced in primary cells or in vivo. This paper summarizes reports on the permissive cells in vitro and in vivo and suggests a hematological cell lineage for dengue virus infection in vivo, with the hope that a new focus will shed light on further understanding of the complexities of dengue disease.
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