Immunologic events in dengue virus infection

DENV is introduced through mosquito bites and infects local immune cells including resident dendritic cells, mast cells, and blood-derived dendritic cells. Cytokines produced by these local immune cells regulate viral replication and further recruit immune cells to the site of infection. Infected cells migrate to local lymph nodes where DENV further replicates and activates B and T cells leading to differentiation of these cells into effector cells. DENV disseminates through the circulation and further amplified the innate and the adaptive immune responses. The cytokines produced by these immune cells activate endothelial cells resulting in the perturbation of vascular integrity and coagulopathy. NS1 protein may act directly on endothelial cells to enhance vascular permeability. These cytokines may affect other cell types including hepatocytes leading to liver injury.