upload thisions of serum aminotransferases that are usually mild are common in

dengue virus infections [94]. Typical pathologic findings in the livers of fatal
cases of dengue include hepatocellular necrosis and Councilman bodies with
relatively little inflammatory cell infiltration, similar to the findings in early
yellow fever virus infection [88]. The pathologic similarities between these two
diseases and the relatively frequent isolation of dengue virus from liver tissues
of fatal cases suggest that liver injury is directly mediated by dengue virus
infection of hepatocytes and Kupffer cells. Dengue virus has been shown to infect
and induce apoptosis in a human hepatoma cell line in vitro [105]. However, immune-
mediated hepatocyte injury is a potential alternative mechanism.

Central nervous system — Rare cases of encephalopathy have been attributed to

dengue virus infections. True encephalitis has been reported, with detection of
dengue virus in brain tissue [106], but this is clearly the exception in humans. In
one series of 100 fatal cases of dengue, no evidence of central nervous system
inflammation was found [88].

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