Poor Innate and Adaptive Immune sensitization in dengue patients: A preliminary observational study on DHF/DSS as an infectious allergic condition

Dengue Fever is a major public health problem leading to serious morbidity and mortality worldwide. There are severe clinical conditions associated with Dengue Fever which may further lead to Dengue Haemorrhagic Fever or Dengue Shock syndrome. The  hypothesis of occurrence of Antibody Dependant Enhancement (ADE) is currently believed to be the immunological basis of DHF/DSS. However, some of the earlier studies and our current work, have shown that ADE might not be the sole cause of severe dengue. To establish its exact cause, so that therapeutic interventions can be made and recovery of patients be ensured, the present study was done. The blood samples were collected from dengue positive patients reporting to Sharda Hospital, India. A thin smear was prepared from 5µl of blood and stained using Leishman stain to count various immune cells. The serum was separated and subjected to RT-PCR to double ensure the presence of virus using Dengue specific primers. 100µl of serum was also taken for detecting Histamine levels using ELISA assay. Blood samples of severe dengue cases was also outsourced for electron microscopy to critically study the effect of virus on the various  immune cells. We observed that the major innate immune cells showed no immunogenic sensitization by the dengue virus but were permissive for infection and led to formation of neutrophil traps. Lymphocytes as gross adaptive immune cells showed elevation but without generating pathogen specific IgM antibodies. Granulocytes such as basophils have shown substantial enhancement pointing the symptoms more as allergic reactions rather than infectious outcomes. The serum histamine level was raised in all the severe patients of dengue. Present paper sensitizes the issue that DHF cases showing subcutaneous haemorrhages could be histamine induced allergy and stage of DSS could be a systemic anaphylaxis due hypersensitivity type 1 reactions. Paper sensitizes further studies in this direction through which use of anti-allergic, anti-histamine drugs could emerge as specific therapeutic intervention of DHF/DSS.