The kinetics of endotoxin and cytokines in dengue hemorrhagic fever

Endotoxin was detected in 63% among 120 dengue hemorrhagic fever (DHF) cases. The proportion of endotoxemia in shock group were higher than that non-shock as well as serum endotoxin level (13.9 and 4.3 pg/ml respectively, p=0.0008). Shock group has 3.0 times risk to have endotoxemia than that non-shock DHF group (OR 3.0; 1.29-7.05 95% Cl). Serum endotoxin concentration increased at the time of shock and decrease after shock recovered. Patients with endotoxemia has 5.8 times higher risk to develop severe dengue infection compared to non-endotoxemia group (OR 5.5; 1.72-21.74 95% Cl). Pre-inflammatory mediator TNF-a can be detected at the beginning of the disease and disappeared on convalescence stage, while IL-6 titer increased at the early convalescence phase as a feed back mechanism to endotoxin and TNF-α.