Exosomes are small extracellular vesicles secreted by cells and have a major role in cell-to-cell signaling. As dengue infection progresses from a mild to a severe form of infection, the exosome's microRNA (miRNA) composition might change, which may contribute to pathogenesis. In this study, a comprehensive analysis of serum exosomal miRNAs was performed and their involvement in dengue virus-induced disease progression in an Indian cohort was assessed. Small RNA-seq showed 50 differentially expressed exosomal miRNAs that were significantly dysregulated during dengue infection. After extensive validation, miR-96-5p was found to be significantly upregulated, whereas miR-146a-5p was significantly downregulated with the progression of disease to severe form. Interestingly, a strong positive correlation was found between the expression levels of miR-96-5p and miR-146a-5p and the platelet levels of the patients. Further, study of miR-146a-5p showed that it regulates the expression of the proteins which are involved in the immune responses. These results suggest that miR-96-5p and miR-146a-5p could be used as diagnostic and prognostic markers for dengue disease progression, in addition to the already available biochemical and pathological parameters. K E Y W O R D S dengue pathogenesis, dengue virus, exosomes, microRNA 1 | INTRODUCTION Dengue virus (DENV) is the causative agent of dengue fever, the most common mosquito-transmitted disease. It is a positive-sense cytoplasmic virus belonging to the Flavivirus genus of the family Flaviviridae. 1 There are four distinct serotypes of the dengue virus, namely DENV-1, DENV-2, DENV-3, and DENV-4, and the prevalence of each serotype differs depending on the geographical location. 2,3 Currently, no specific medical treatment is available for this disease, and no effective vaccine has been developed. The only licensed vaccine, Dengvaxia, has low efficacy against serotypes 1 and 2. 4Based on its severity, dengue infection has been categorized into different stages: dengue without warning (Plan A), dengue with warning (Plan B), and severe dengue fever (dengue hemorrhagic fever/dengue shock syndrome) (Plan C). 5 Dengue pathogenesis has been shown to be influenced mainly by the host immune response, leading to a cytokine storm, immune enhancement, secondary infection, and variation in viral serotype. 6 Not much progress has been made in identifying molecules that have a role in disease