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Alternate hypothesis on the pathogenesis of dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) in dengue virus infection

10 Jul 2008

Paul Chinnock

Source: Experimental Biology and Medicine (see original article)

Citation: Noisakran S, Perng GC (2008). Alternate hypothesis on the pathogenesis of dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) in dengue virus infection. Exp Biol Med (Maywood); 233(4):401-8

Dengue fever is increasing worldwide. The World Health Organization (WHO) estimates that some 2.5 billion people – two fifths of the world’s population – are now at risk of infection. Only a minority of cases develop into the more serious dengue haemorrhagic fever (DHF) /dengue shock syndrome (DSS); for example, WHO says that of the 890 000 reported cases of dengue in the Americas in 2007, 26 000 cases (2.9%) were DHF. However, DHF is a very severe condition; up to 5% of cases die, with children particularly at risk.

There is no agreement as to what causes some cases to progress to DHF. The authors of this review take a very broad look at the issue and discuss a number of factors which may be responsible.

Further information on dengue and on DHF may be found on a WHO factsheet.

Note: This article is published in a journal which is not open access. To see the full article a subscription to the Experimental Biology and Medicine is therefore required. In some developing countries, readers who are based in institutions may be able to access it through the HINARI programme.

Abstract

Dengue fever, caused by infection with dengue virus, is not a new disease, but recently because of its serious emerging health threats, coupled with possible dire consequences including death, it has aroused considerable medical and public health concerns worldwide. Today, dengue is considered one of the most important arthropod-borne viral diseases in humans in terms of morbidity and mortality. Globally, it is estimated that approximate 50 to 100 million new dengue virus infections occur annually. Among these, there are 200,000 to 500,000 cases of potential life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), characterized by thrombocytopenia and increased vascular permeability. The death rate associated with the more severe form DHF/DSS is approximately 5%, predominantly in children under the age of 15. Although intensive efforts have been made to study the early clinical pathophysiology of dengue infection with the objective to identify the potential cause of DHF, results or data that have accumulated from different regions of the world involving studies of different ethnicity groups are inconsistent at present in terms of identifying a unified hypothesis for the pathogenesis of DHF/DSS. Thus, the potential mechanisms involved in the pathogenesis of DHF and DSS remain elusive. The purpose of this review is to identify alternate factors, such as innate immune parameters, hyper-thermal factors, conditioning of neutralizing antibody, concept of vector transmission, and physical status of virus in viremic patients that may play a role in the induction of DHF and DSS, which might have directly or indirectly contributed to the discrepancies that are noted in the literature reported to date. It is the hope that identification of an alternative explanation for the pathogenesis of DHF/DSS will pave the way for the institution of new strategies for the prevention of this complicated disease.