Incidence of Cardiac Manifestations in Children with Dengue Fever: A Cross Sectional Study

Abstract

Objective: The aim of our study was to explore the incidence of cardiac involvement in children with dengue infection admitted in a tertiary care hospital and to evaluate the features of cardiac involvement with the severity of dengue fever. Methods: This was a cross-sectional study conducted from September 2014 to August 2016. A total of 130 patients with confirmed dengue NS1 antigen or IgM antibody positivity between the ages of 1 month and 18 years were evaluated. On the third day of admission, blood samples for cardiac markers were collected, and electrocardiograms (ECG), and echocardiograms were performed for each patient. Results: Of the 130 dengue patients in the study, 60 (46.2%) were males and 70 (53.8%) were females (male to female ratio, 1:1.16). Cardiac involvement was present in 60 (46.2%) children and was more prominent in children with severe dengue (72.7%), followed by dengue with warning symptoms (53.8%) and dengue fever (28.6%). There was no significant correlation between cardiac involvement and primary/secondary dengue. Both ECG and echocardiography changes were significantly correlated with dengue severity, as opposed to cardiac markers. Conclusions: Cardiac involvement was present in children with dengue. Evaluation with ECG, echocardiography, and cardiac markers such as CPK-MB are required for the management of cardiac complications in children with dengue. Our study showed an association between cardiac involvement and the severity of dengue. Further studies should be framed, and follow-up of dengue patients with cardiac involvement is necessary for therapeutic management.

Immunocompetent Mice Infected by Two Lineages of Dengue Virus Type 2: Observations on the Pathology of the Lung, Heart and Skeletal Muscle

“…Although data on the cardiac involvement in dengue are scarce, lately, heart involvement has been increasingly reported [14][15][16][17][18] and it is mostly associated with severe cases [14,15,18]. Main findings include atrioventricular conduction disorders, supraventricular arrhythmias, myocarditis, bradycardia, tachycardia, pericardial effusion, diastolic dysfunction and increased levels of cardiac enzymes [4,16,18,73].…”

“…Although data on the cardiac involvement in dengue are scarce, lately, heart involvement has been increasingly reported [14][15][16][17][18] and it is mostly associated with severe cases [14,15,18]. Main findings include atrioventricular conduction disorders, supraventricular arrhythmias, myocarditis, bradycardia, tachycardia, pericardial effusion, diastolic dysfunction and increased levels of cardiac enzymes [4,16,18,73]. Cardiomegaly has been reported in cases of DENV infection [13,15,16,74] and it can be caused by coronary artery disease, hypertension, valvulopathies, pulmonary diseases and myocarditis, among other complications [75].…”

“…Respiratory complications vary from dyspnea to acute respiratory failure and/or acute respiratory distress syndrome [11]. Since its first report in 1926 [12], cardiac involvement during dengue has been increasingly reported and it is mostly associated with severe cases [13][14][15][16][17][18]. Several arboviruses have tropism for muscle cells and can cause pathological alterations of the skeletal muscle [19].…”