Dengue fever is one of those unique diseases where host immune responses largely determine the pathogenesis and its severity. Earlier studies have established the fact that dengue virus (DENV) infection causes haemorrhagic fever and shock syndrome, but it is not directly responsible for exhibiting these clinical symptoms. It is noteworthy that clinically, vascular leakage syndrome does not develop for several days after infection despite a robust innate immune response that elicits the production of proinflammatory and proangiogenic cytokines. The onset of hyperpermeability in severe cases of dengue disease takes place around the time of defervescence and after clearance of viraemia. Extracellular vesicles are known to carry biological information (mRNA, miRNA, transcription factors) from their cells of origin and have emerged as a significant vehicle for horizontal transfer of stress signals. In dengue virus infection, the relevance of exosomes can be instrumental since the majority of the immune responses in severe dengue involve heavy secretion and circulation of pro-inflammatory cytokines and chemokines. Here, we present an updated review which will address the unique and puzzling features of hyperpermeability associated with DENV infection with a special focus on the role of secreted extracellular vesicles.

中文翻译：

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登革出血热：通过外泌体完成工作？

登革热是一种独特的疾病，宿主的免疫反应在很大程度上决定了发病机制及其严重程度。早期研究已经证实登革热病毒（DENV）感染会导致出血热和休克综合征，但它并不是表现出这些临床症状的直接原因。值得注意的是，在临床上，尽管强大的先天免疫反应会引发促炎和促血管生成细胞因子的产生，但血管渗漏综合征在感染后几天内不会出现。严重登革热病例中，通透性过高发生在退热前后和病毒血症清除后。众所周知，细胞外囊泡携带来自其来源细胞的生物信息（mRNA、miRNA、转录因子），并已成为应激信号水平转移的重要载体。在登革热病毒感染中，外泌体的相关性可能发挥重要作用，因为严重登革热的大多数免疫反应涉及促炎细胞因子和趋化因子的大量分泌和循环。在这里，我们提出了一篇更新的综述，它将解决与 DENV 感染相关的通透性过高的独特且令人费解的特征，特别关注分泌的细胞外囊泡的作用。