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Follicular helper T cells (T_FH) are specialized CD4 T cells required for B-cell help and antibody production.

Given the postulated role of immune activation in dengue disease, we measured the expansion and activation of T_FH in the circulation (peripheral T_FH [pT_FH]) collected from Thai children with laboratory-confirmed acute dengue virus (DENV) infection.

We found significant expansion and activation of pT_FH subsets during acute infection with the highest frequencies of activated pT_FH (PD1^hi pT_FH and PD1⁺CD38⁺ pT_FH) detected during the critical phase of illness. Numbers of activated pT_FH were higher in patients with secondary compared with primary infections and in patients with more severe disease. We also found a positive correlation between the frequencies of activated pT_FH and the frequencies of plasmablasts …