Jih Jin TsaiKulkanya ChokephaibulkitPo Chih ChenLi Teh LiuHui Mien HsiaoYu Chih LoGuey Chuen PerngKaohsiung Medical University Chung-Ho Memorial HospitalKaohsiung Medical UniversityMahidol UniversityChung Hwa College of Medical Technology TaiwanEmory University School of MedicineNational Cheng Kung University2018-10-192018-10-192013-12-05Journal of Biomedical Science. Vol.20, No.1 (2013)14230127102177702-s2.0-84888997780https://repository.li.mahidol.ac.th/handle/20.500.14594/31144Dengue is becoming recognized as one of the most important vector-borne human diseases. It is predominant in tropical and subtropical zones but its geographical distribution is progressively expanding, making it an escalating global health problem of today. Dengue presents with spectrum of clinical manifestations, ranging from asymptomatic, undifferentiated mild fever, dengue fever (DF), to dengue hemorrhagic fever (DHF) with or without shock (DSS), a life-threatening illness characterized by plasma leakage due to increased vascular permeability. Currently, there are no antiviral modalities or vaccines available to treat and prevent dengue. Supportive care with close monitoring is the standard clinical practice. The mechanisms leading to DHF/DSS remains poorly understood. Multiple factors have been attributed to the pathological mechanism, but only a couple of these hypotheses are popular in scientific circles. The current discussion focuses on underappreciated factors, temperature, natural IgM, and endotoxin, which may be critical components playing roles in dengue pathogenesis. © 2013 Tsai et al.; licensee BioMed Central Ltd.Mahidol UniversityBiochemistry, Genetics and Molecular BiologyMedicineReviewSCOPUS10.1186/1423-0127-20-88