TNF and dengue disease: Therefore, the changes produced by dengue may go unnoticed, which justifies the need to clarify this diagnosis when a pregnant woman presents with fever.44,45 Some pathophysiological mechanisms have been proposed for dengue infection For example, the up-regulation of proinflammatory cytokines (interleukin 6 (IL-6), interleukin 8 (IL-8) and tumour necrosis factor alpha (TNF-α)) may result in alterations to normal gestational physiology.