Main Article Content

Priyanka Sehrawat
Ashutosh Biswas
Prabhat Kumar
Paras Singla
Naveet Wig
Lalit Dar
Rita Sood


Cytokine storm, severe dengue


Objective: Dengue infection is a rapidly spreading vector-borne disease and is endemic in Indian subcontinent. It has varied manifestations ranging from subclinical infection to severe fatal shock syndrome. This study aimed to estimate cytokine level in dengue patients and correlate them with dengue severity.

Methods: Cases of Dengue fever diagnosed in the Department of Medicine of our institute from July 2015 to November 2016 were included in the study. The clinical features, biochemical, hematological and radiological parameters along with cytokine levels (Interferon-gamma, Interleukin-6 and Tumour Necrosis Factor-alpha) were recorded in all patients.

Results: Out of 80 confirmed cases of dengue included in the study, 50 had non severe dengue (Group 1) and 30 patients had severe dengue (Group 2). The mean levels of serum TNF-? in group 2 (213.17±266.9 pg/mL, median= 62.5 pg /ml) were significantly higher than the mean levels in patients in dengue group 1 (112.8±213.1 pg/mL, median=20pg/ml) (p<0.043). Similarly, the mean levels of serum IFN-? in group 2 (28.4±56.2 pg/mL, median=10.5pg/ml) were significantly higher than the mean levels in patients in group 1 (11.8 ± 9.2pg/mL, median=8.5pg/ml) (p<0.002). The levels of IL-6 were also higher in severe dengue group as compared to non severe dengue but these results were not significant (p>0.05).

Conclusion: Increased cytokines may play a role in pathogenesis of severe manifestations of dengue and can be targeted to halt the progression of disease severity


Download data is not yet available.
Abstract 2324 | PDF Downloads 626 HTML Downloads 224


1. World Health Organization. Regional Office for South-East Asia. Comprehensive guidelines for prevention and control of dengue and dengue hemorrhagic fever. New Delhi, India: World Health Organization Regional Office for South-East Asia; 2011.
2. Martina BE, Koraka P, Osterhaus AD. Dengue virus pathogenesis: an integrated view. Clin Microbiol Rev. 2009;22:564-581.
3. World Health Organization and the Special Programme for Research and Training in Tropical Diseases (TDR). Dengue guidelines for diagnosis, treatment, prevention and control: new edition (published 2009).
4. Senanayake S. Dengue fever and dengue haemorrhagic fever--a diagnostic challenge. Australian Family Physician. 2006;35:609–612.
5. Gurugama P, Garg P, Perera J, Wijewickrama A, Seneviratne SL. Dengue viral infections. Indian J Dermatol. 2010;55:68–78.
6. Rowe EK, Leo Y-S, Wong JGX, Thein T-L, Gan VC, Lee LK, Lye DC. Challenges in dengue fever in the elderly: atypical presentation and risk of severe dengue and hospital-acquired infection. PLoS Negl Trop Dis. 2014;8:e2777.
7. Sumarmo null, Wulur H, Jahja E, Gubler DJ, Suharyono W, Sorensen K. Clinical observations on virologically confirmed fatal dengue infections in Jakarta, Indonesia. Bull World Health Organ. 1983;61:693–701.
8. Bethell DB, Flobbe K, Cao XT, Day NP, Pham TP, Buurman WA, Cardosa MJ, White NJ, Kwiatkowski D. Pathophysiologic and prognostic role of cytokines in dengue hemorrhagic fever. J Infect Dis. 1998;177:778–782.
9. Green S, Vaughn DW, Kalayanarooj S, Nimmannitya S, Suntayakorn S, Nisalak A, Lew R, Innis BL, Kurane I, Rothman AL, Ennis FA. Early immune activation in acute dengue illness is related to development of plasma leakage and disease severity. J Infect Dis. 1999;179:755–762.
10. Kumar A, Rao CR, Pandit V, Shetty S, Bammigatti C, Samarasinghe CM. Clinical Manifestations and Trend of Dengue Cases Admitted in a Tertiary Care Hospital, Udupi District, Karnataka. Indian J Community Med 2010;35:386–390.
11. Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R, Mathur A, Misra AK, Srivastava KL, Chaturvedi UC. A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India. Southeast Asian J Trop Med Public Health. 1999;30:735–740.
12. Díaz-Quijano FA, Martínez-Vega RA, Villar-Centeno LA. Early indicators of severity in dengue virus infection. Enferm Infecc Microbiol Clín. 2005;23:529–532.
13. Guzmán MG, Alvarez M, Rodriguez R, Rosario D, Vázquez S, Valdés L, Cabrera MV, Kourí G. Fatal dengue hemorrhagic fever in Cuba, 1997. Int J Infect Dis. 1999;3:130–135.
14. Brasier AR, Ju H, Garcia J, Spratt HM, Victor SS, Forshey BM, Halsey ES, Comach G, Sierra G, Blair PJ, Rocha C, Morrison AC, Scott TW, Bazan I, Kochel TJ; Venezuelan Dengue Fever Working Group. A Three-Component Biomarker Panel for Prediction of Dengue Hemorrhagic Fever. Am J Trop Med Hyg. 2012;86:341–348.
15. Jayashree K, Manasa GC, Pallavi P, Manjunath GV. Evaluation of Platelets as Predictive Parameters in Dengue Fever. Indian J Hematol Blood Transfus. 2011;27:127–130.
16. Rachman A, Rinaldi I. Coagulopathy in dengue infection and the role of interleukin-6. Acta Medica Indones. 2006;38:105–108.
17. Mahmuduzzaman M, Chowdhury AS, Ghosh DK, Kabir IM, Rahman MA, Ali MS. Serum transaminase level changes in dengue fever and its correlation with disease severity. Mymensingh Med J. 2011;20:349–355.
18. Pancharoen C, Rungsarannont A, Thisyakorn U. Hepatic dysfunction in dengue patients with various severity. J Med Assoc Thai. 2002;85 Suppl 1:S298-301.
19. Pang T, Cardosa MJ, Guzman MG. Of cascades and perfect storms: the immunopathogenesis of dengue haemorrhagic fever-dengue shock syndrome (DHF/DSS). Immunol Cell Biol. 2007;8:43–45.
20. Bozza FA, Cruz OG, Zagne SM, Azeredo EL, Nogueira RM, Assis EF, Bozza PT, Kubelka CF.Multiplex cytokine profile from dengue patients: MIP-1beta and IFN-gamm as predictive factors for severity. BMC Infect Dis. 2008;8:86.
21. Azeredo EL, Zagne SM, Santiago MA, Gouvea AS, Santana AA, Neves-Souza PC, Nogueira RM, Miagostovich MP, Kubelka CF. Characterisation of lymphocyte response and cytokine patterns in patients with dengue fever. Immunobiology. 2001;204:494–507.
22. Priyadarshini D, Gadia RR, Tripathy A, Gurukumar KR, Bhagat A, Patwardhan S, Mokashi N, Vaidya D, Shah PS, Cecilia D. Clinical Findings and Pro-Inflammatory Cytokines in Dengue Patients in Western India: A Facility-Based Study. PLoS ONE. 2010;5:e8709.