Pathophysiologic and prognostic role of proinflammatory and regulatory cytokines as a proinflammatory and regulatory cytokine in dengue fever

Cytokines are important immune-modulators and improper T-cell activation can lead to cytokine storms which are believed to result in endothelial permeability and leakage, a typical feature of Dengue disease progressing into a more severe stage. Many cytokines have been implied in causing severe Dengue manifestations among which IL-10 poses to be an important one. Inflammatory cytokines such as TNFα and IFN γ can be pointed out in Dengue pathogenesis and prognosis. Therefore, we sought to investigate the T cell activation of Dengue infected patients via these three markers and asses their levels and correlate cytokine levels with disease severity and clinical outcomes.Samples using standard blood collection techniques were obtained from patients with clinical signs suggestive of dengue. A haematological was obtained subsequently. Serological markers including IgM and NS1 were assessed using ELISA following which ELISA will be done for immunological markers including TNFα, IFN γ (markers of pro-inflammatory response and IL-10 (marker for regulatory response).There was a significant correlation between IL10 and clinical features. There was no significant correlation between TNF alpha and clinical features. IFN gamma had a positive correlation with the clinical features. There was a positive cumulative correlation between clinical features, platelet counts, IL10 and TNF alpha but not with IFN gamma contrary to its correlation as a separate entity with just the clinical features.The present study clearly indicates that IL10 is a highly sensitive marker of Severe Dengue and can be used as a screening tool in Secondary Dengue patients or those with warning signs. TNF alpha as it correlates strongly with patients with warning signs can be used for prognosis is patients presenting with symptoms. However, interferon gamma correlates strongly with low platelet counts and can be a measure to screen patients presenting with fever with thrombocytopenia.