“…This is thought, in part, to be the result of a proinflammatory cytokine storm driven by infected macrophages (9,15,16,(42)(43)(44)56). Initiation of a systemic inflammatory response results in severe hematological and vascular perturbations, ultimately leading to cardiovascular collapse in a manner not dissimilar to septic shock (3,17,18,20,21,40,52,53). In addition to hemorrhage, severe widespread apoptosis of infected macrophages and uninfected lymphocytes is a prominent feature of the disease; this is also likely related to markedly elevated proinflammatory cytokine levels (19,33,37,43).…”