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As a result, less blood circulates in the blood vessels, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. Furthermore, dysfunction of the bone marrow due to infection of the stromal cells leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever.[43]Once inside the skin, dengue virus binds to Langerhans cells (a population of dendritic cells in the skin that identifies pathogens).[43] The virus enters the cells through binding between viral proteins and membrane proteins on the Langerhans cell, specifically the C type lectins called DC SIGN, mannose receptor and CLEC5A.[28] DC SIGN, a non specific receptor for foreign material on dendritic cells, seems to be the main point of entry.[31] The dendritic cell moves to the nearest lymph node. Meanwhile, the virus genome is translated in membrane bound vesicles on the cell's endoplasmic reticulum, where the cell's protein synthesis apparatus produces new viral proteins that replicate the viral RNA and begin to form viral particles.
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