sThe major pathophysiologic hallmarks of
DHF/DSS are abnormal hemostasis and increased
vascular permeability, leading to plasma
leakage. A critical loss of plasma leads to hypovolemic
shock and death (WHO, 1999a). The
synergy between malnutrition and infection is
well recognized (Thisayakorn and Nimmanitya,
1993). The development of DF/DHF depends on
the host immune response. Malnourished children
have less severe DHF/DSS because they
have a decreased cellular immune response
(Halstead, 1997). Obese children are expected
to have a stronger immune response than malnourished
children so they are at higher risk of
developing DF/DHF.