TNF and Thrombocytopenia: As mentioned, DENV induces pathological changes related to increased production of proinflammatory cytokines44,57 which can affect the uterus by stimulating the production of proteins that promote uterine contractions, potentially leading to preterm delivery.58 In addition, among these proinflammatory cytokines is TNF-α, which is related to bleeding, favoring thrombocytopenia and endothelial dysfunction59,60; in addition, antibodies are produced that cross-react with plasma proteins, platelets and the endothelium, which also leads to hemorrhagic symptoms.59