Mast cell activation in severe dengue

Abstract

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Background: Mast cells have been shown to play a role in the pathogenesis of dengue, in mouse i models. In our previous studies, we found that platelet activating factor (PAF), which is a mast cell j product, played an important role in vascular leak. Therefore, we set to investigate the potential role of mast cell activation in the pathogenesis of dengue virus infection. | Methods: Serial twice daily blood samples were obtained from 38 adult patients with acute dengue | from the time of admission to discharge. Mast cell tryptase level; viral loads, secretory phospholipase (sPLA2) activity and platelet activating factor (PAF) levels were assessed. All clinical and laboratory features were serially recorded until discharge of the patients. Disease severity was classified based j on the W HO 2011 dengue guidelines. Results: sPLA2 activity, mast cell tryptase level, and PAF levels were significantly elevated during the critical period in patients with severe dengue (SD) infection compared to non severe dengue infection (NSD). The highest sPLA2 activity, tryptase and PAF levels were seen on day 6 of illness, which co- , incided with the critical phase. Mast cell tryptase (p=0.006), PAF levels (p=0.01) and sPLA2 activity (p=0.01) were significantly higher in those with SD when compared to NSD during the critical phase. Conclusion: mast cell tryptase level, secretory phospholipase (sPLA2) activity, and platelet activating factor (PAF) levels were significantly higher in SD indicating mast cell activation which is likely to play a role in the pathogenesis of vascular leak in severe dengue.