Cytotoxic factor in dengue haemorrhagic fever

Objective: Cytotoxic factor is a unique pathogenesis-associated cytokine that is produced in mice (mCF) and man (hCF) during dengue virus infection. This study was undertaken to investigate the prevalence of hCF and its relationship to the duration and severity of the illness, and to ascertain its role, if any, in the pathogenesis of dengue fever (DF) and dengue haemorrhagic fever (DHF). Methods: Peripheral venous blood was collected from the patients of various grades and on different days after the onset of clinical illness. Sera were collected from a total of 333 cases, and analysed for the presence of hCF by inhibition ELISA and dot blot tests. Result: The positivity for hCF was 100% in cases of DHF grades Ill and IV, while overall positivity was seen in 295 out of 333 (88%) cases studied. Sera collected from the 1st to the 20th day of illness were positive for hCF. This was not seen at later periods. A majority of cases (52%) were below 15 years of age and peak positivity of 96% was noticed in the age-group of 11-15 years. The mean inhibition value of the ELISA was lowest (40 +/- 8%) in cases of DF and was highest (70 +/- 10%) in DHF grade IV, and the peak titres were found on the first 4 days of the illness. Conclusion: The findings show the presence of hCF in the majority of cases. It is detectable up to the 20th day of illness and may suggest an association of higher levels of hCF with the onset and severity of the illness.