Sensitive immunoenzymatic assays were used to study the levels of tumor necrosis factor-a (TNF-a), interleukin-6(IL-6), and IL-lfi in sera from dengue-infected patients obtained during the 1989— 1990outbreak ofdengue-3 in Tahiti, French Polynesia. The patients, both children (n= 47) and adults (n= 18), were clinically classified as having dengue hemorrhagic fever (DHF) and graded according to the severity of illness (grade I

= fever, grade II= fever with spontaneous hemorrhagic manifestations, grade III= cir culatory failure, grade IV= deep shock). The serum samples were obtained from day 1to day 10 after the onset of the disease. High levels of TNF-a were observed in dengue infected children of all severity grades. The highest values of TNF-a were found before day 6 after the onset of the infection, these values decreased from day 6 to day 10. The highest values were observed in sera from grade III and IV patients. High values of IL-6 were observed in serum samples of grade I and II patients on day 1, which decreased on day 4, and by day 5 were similar to those obtained from 25 control children. In grade III and IV patients, the highest values of IL-6 were observed from day 3 to day 5 after the onset of infection; after day 5, these values were very low. The highest values of IL-6 in grade III patients were accompanied by elevated values of TNF-a and were observed in serum obtained on the day the patient went into shock (dengue shock syndrome [DSS]). The IL-6 values were normal one day before and one day after the patient went into shock. The values of IL-1@ 9were similar to those of 25 control children. Serum samples from dengue-infected adults, obtained from day 4 to day 10 after the onset of disease, showed moderately high levels ofTNF-a compared with those ofdengue-infected children. In some adult patients, IL-6 values increased and in all the patients, IL-1$ values were similar to those of healthy adults. Our results show an inconsistency in TNF-a and IL-6 production indengue-infected patients that probably has important implications inthe physiopathology of DHF/DSS.

Dengue is an acute infectious disease of viral etiology. Dengue viruses (four serotypes) are a major cause of morbidity and mortality through out subtropical and tropical areas. ― 2Patients in fected with a dengue virus may develop severe diseases, including dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). ― 2