Inflammatory mediators in dengue virus infection in children: interleukin-6 and its relation to C-reactive protein and secretory phospholipase A2.

Abstract

Abstract. To assess the potential role of interleukin-6 (IL-6) in the pathogenesis of dengue virus infection, levels of this cytokine were measured in children with dengue virus infection on admission to the hospital. As presumed surrogate markers of IL-6, C-reactive protein (CRP) and secretory phospholipase A2 (sPLA2) were measured. Three groups were studied: 33 apparently healthy children as negative controls, 11 children with bacterial infections as positive controls, and 186 children with serologically documented dengue virus infection. One-hundred and fifteen patients had dengue fever (DF) and 71 had dengue hemorrhagic fever (DHF). Compared with healthy controls, dengue shock syndrome (DSS) patients had significantly higher levels of IL-6 on admission (P Ͻ 0.05), comparable with those in positive controls. Dengue patients with shock had significantly higher levels of IL-6 than normotensive patients (P Ͻ 0.001) and higher levels of IL-6 were associated with a higher incidence of ascites. C-reactive protein concentrations in dengue patients and in healthy children were not different, but lower than in children with bacterial infections (P ϭ 0.008). Secretory phospholipase A2 levels were higher in dengue patients than in apparently healthy children (P Յ 0.05) and similar to those in children with bacterial infection. Dengue shock syndrome patients had significantly higher sPLA2 concentrations than normotensive patients (P ϭ 0.02). These data indicate that IL-6 and sPLA2 may have a pathogenetic role only in the most severe forms of dengue virus infection.

microRNA expression profiling and bioinformatic analysis of dengue virus-infected peripheral blood mononuclear cells

“…In particular, high concentrations of cytokines, including IFN-γ, TNF-α and IL-10, in the serum of patients with severe DENV infections have been widely reported in Vietnam (15), India (16) and Cuba (17), as well as elevated levels of IL-6 in children with ascites (18). Additional studies have demonstrated that endothelial cells induce a high level of immune cell-mediated recruitment of cytokines IL-6/8, CXCL9/10/11, CCL5 and IL-7 (19).…”

The pathogenesis of dengue

“…75 TNF- promotes increased endothelial permeability and it's plausible that increased levels of this cytokine could result in a more severe disease course. 76 It is likely that cytokines play a mutually synergistic role at the endothelial surface contributing to the development of the transient plasma leak, however the exact dynamic of this interaction has yet to be elucidated.…”

Endemic (Murine) Typhus in Returned Travelers from Asia, a Case Series: Clues to Early Diagnosis and Comparison with Dengue

“…CRP has previously been found to be low in uncomplicated dengue fever in adults and children, with modest elevation in some cases of severe disease. 11,12 We suggest that, if neutropenia is absent or CRP is significantly elevated, alternative diagnoses to dengue should be sought, and strong consideration should be given to the empiric use of doxycycline.…”