Endothelial dysfunction/reduced nitric oxide bioavailability is associated with worse plasma leakage in dengue patients and occurs early in the course of the disease. Endothelial dysfunction correlates with lower plasma l-arginine and higher arginase-1 levels.

Background: Dengue is the most common arboviral infection globally; a minority of patients develop shock due to profound plasma leak through a disrupted endothelial barrier. Understanding of the pathophysiology underlying plasma leak is incomplete, but emerging evidence indicates a key role for degradation of the endothelial glycocalyx. Conclusions: We present the first human in vivo evidence of glycocalyx disruption in dengue, with worse visual glycocalyx damage and higher plasma degradation products associated with more severe plasma leak.

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