Pathophysiology
Mnemonic: ABC
- Antibody-Dependent Enhancement: Non-neutralizing antibodies (Pre-M-specific antibodies and NS1-specific antibodies) forms virus-antibody complex, which enters the host cells and replicates generating high virus titers in blood
- Bleeding manifestations:
- Endothelial dysfunction and plasma leakage (Anti-NS1 antibody acts as autoantibodies and cross-react with non-infected endothelial cells)
- Coagulopathy
- Thrombocytopenia (Bone marrow suppression + Platelet destruction)
- Cytokine storm: CD4+ and CD8+ T cells, specific to the dengue virus, cause lysis of virus-infected cells and produce cytokines such as IFN-gamma, TNF-alpha, and lymphotoxin
Classification
Lab Diagnosis
- NS1 antigen and RNA PCR – Detectable from day 1
- IgM antibody:
- Rises after 2 days of symptom onset
- Peaks at 2 weeks
- Normalizes by 2 months
