Schematic Diagram

Predisposing Geographical area – tropical islands in the Pacific (Philippines) and Asia

Precipitating Environmental conditions (open spaces with water pots, and plants) Immunocompromise Mosquito carrying dengue virus Soldier Sweaty skin

Aedes aegypti (dengue virus carrier): 8-12 days of viral replication on mosquitos’ salivary glands

Bite from mosquito (Portal of Entry in the Skin) Allowing dengue virus to be inoculated towards the circulation/blood (Incubation Period: 3-14 days

Virus disseminated rapidly into the blood and stimulates WBCs including B lymphocytes that produces and secretes immunoglobulins (antibodies), and monocytes/macrophges, neutrophils

Antibodies attach to the viral antigens. tumor necrosis factor. urokinase and platelet activating factors which stimulates WBCs and pyrogen release Entry to the bone marrow . and then monocytes/macrophages will perform phagocytosis through Fc receptor (FcR) within the cells and dengue virus replicates in the cells Recognition of dengue viral antigen on infected monocyte Entry to the spleen Release of cytokines which consist of vasoactive agents such as interleukins.

Dengue Virus ultimately targets liver and spleen parenchymal cells where infection produces apoptosis/cell death Cellular direct destruction and infection of red bone marrow precursor cells as well as immunological shortened platelet Hepatosplenomegaly Thrombocytopenia Dengue Hemorrhagic Increase number and size of the pores in the capillaries which leads to a leakage of fluid from the blood to the interstitial fluid (capillary leakage) of the different .

Pleural effusion Ascite Recovery Complications: Intense bleeding Pulmonary Edema Shock Very low blood pressure Liver cirrhosis Death .

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