Lymphocytic myocarditis at autopsy in patients with dengue fever

Torres, Alba; Braga, Deborah Nunes de Melo; Muniz, Felipe Nobre; Mendonça, Cindy Vitalino; Oliveira, Denise Nunes; Souza, Emilia Tome de; Burke, Allen; Távora, Fábio

doi:10.1016/j.bjid.2013.03.009

Cited by 6 publications

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References 5 publications

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“…Severe tissue damage with hemorrhage, interstitial edema with inflammatory cell infiltration, and necrosis of myocardial fibers have been noted [69]. Both focal and diffuse myocarditis have been demonstrated in patients dying of dengue, with inflammation and infiltration by lymphocytes, neutrophils, and eosinophils [70]. Pericarditis has also been demonstrated.…”

Section: Histopathologymentioning

confidence: 99%

Cardiac involvement in dengue infection

Shivanthan

Navinan

Constantine

et al. 2015

J Infect Dev Ctries

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Introduction: Dengue is endemic in the tropics, and complications involving organ systems are seen with varying incidence. Methodology: We performed a systematic review. MEDLINE, EMBASE, Scopus SciVerse, Google Scholar, and LILACS were searched for papers providing information on cardiac involvement in dengue. Results: Cardiac involvement is not uncommon in dengue infection and is often transient, but may be associated with significant morbidity and even mortality. Direct viral invasion, immune mechanisms, electrolyte imbalance, derangement of intracellular calcium ion storage, lactic acidosis, and ischemia due to hypotension all play a role in myocardial dysfunction. The manifestations of cardiac involvement include clinical, electrocardiographic, echocardiographic, cardiac enzyme, and histopathologic abnormalities. Echocardiography appears to be a useful tool for detecting myocardial involvement and should be performed in patients with electrocardiographic abnormalities or hemodynamic instability. Treatment is largely supportive, though there are some anecdotal reports of improvements with specific agents. Conclusions: Knowledge on cardiac manifestations in dengue is limited, and further studies are needed to establish the exact pathophysiology and role of specific agents in the prevention and treatment of cardiac complications in dengue.

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Section: Histopathologymentioning

confidence: 99%

Cardiac involvement in dengue infection

Shivanthan

Navinan

Constantine

et al. 2015

J Infect Dev Ctries

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Dengue Virus and Other Flaviviruses (Zika): Biology, Pathogenesis, Epidemiology, and Vaccine Development

Alves

Ángel

2017

Human Virology in Latin America

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Heart and liver are infected in fatal cases of dengue: three PCR based case studies

et al. 2018

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BackgroundDengue is a global problem mainly in the tropics. Meticulous clinical management of cases has reduced the death rate significantly, but large numbers of people still succumb to severe complications of the infection. Presence of myocarditis is often overlooked leading to a poor outcome. Clinical management guidelines of dengue do not stress the importance of myocarditis as a manifestation in dengue infection. Severe hepatic dysfunction also needs emphasis.Case presentationWe present three patients who had come to hospital on the 3rd day of fever. Two of them (case 1 and 3) were in shock on admission and case 2, who was stable on the3rd day, went into the critical phase and developed shock while in the hospital on the 4thday. All three had tachycardia on admission that got worse with time. The clinical course was unstable with fluctuations in urine output and deterioration of organ function. Despite frequent monitoring and life support they survived only 2–3 days in hospital. All three patients had myocarditis during the critical phase. In the first case, myocarditis was confirmed by troponin estimation and echocardiogram. In the second and third cases, histopathology confirmed myocarditis. Haemorrhagic necrosis of the liver was found in case 2 and 3 with exponential rise of transaminases. In all three cases, viral RNA was detected in both heart and liver tissues by PCR amplification.ConclusionsWe stress that detection of myocarditis and liver involvement in any dengue patient is important from the onset of the illness where treatment should be tailored to prevent development of hypotension. Our findings are novel as PCR and histology are rarely done on tissues of deceased dengue patients in the world. Studies are needed to find therapeutic interventions to reverse cardiac and hepatic dysfunction in dengue infection.

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Lymphocytic myocarditis at autopsy in patients with dengue fever

Cited by 6 publications

References 5 publications

Cardiac involvement in dengue infection

Cardiac involvement in dengue infection

Dengue Virus and Other Flaviviruses (Zika): Biology, Pathogenesis, Epidemiology, and Vaccine Development

Heart and liver are infected in fatal cases of dengue: three PCR based case studies

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