Early immune activation in acute dengue illness is related to development of plasma leakage and disease severity

T lymphocyte activation and increased cytokine levels have been described i n retrospective studies of children presenting with dengue hemorrhagic feve r (DHF), Serial plasma samples obtained in a prospective study of Thai chil dren presenting with <72 h of fever were studied. Plasma levels of 80-kDa s oluble tumor necrosis factor receptors (sTNFRs) were higher in children who developed DHF than in those with dengue fever (DF) or other nondengue febr ile illnesses (OFIs) and were correlated with the degree of subsequent plas ma leakage. Soluble CD8 and soluble interleukin-2 receptor levels were also elevated in children with DHF compared with those with DE Interferon-gamma and sTNFR 60-kDa levels were higher in children with dengue than in those with OFIs, TNF-alpha was detectable more often in DHF than in DF or OFIs (P < .05), These results support the hypothesis that immune activation contri butes to the pathogenesis of DHE Further studies evaluating the predictive value of sTNFR80 for DHF are warranted.