Prevalence and Outcomes of Myocarditis in Dengue-Infected Patients Admitted to a Tertiary Care Hospital of Low-Middle Income Country

Baqi, Abdul; Rehman, Fazal Ur; Memon, Pirbhat Shams; Omair, Syed Furrukh

doi:10.5334/gh.1129

Cited by 9 publications

(12 citation statements)

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“…Severe dengue is characterized by bleeding, and plasma leakage from capillaries resulting in cardiovascular shock, and manifestations that can overlap with acute myocarditis . Postmortem examination of hearts from a series of 5 patients with fatal dengue confirmed inflammatory infiltrates consistent with myocarditis (Table 1) …”

Section: Methodsmentioning

confidence: 99%

“…Symptoms of dengue virus infection range from mild fever to shock syndrome . Dengue-associated acute myocarditis has been reported in 4% to 7% of hospitalized patients with dengue from Pakistan and India, based on troponin increase and echocardiographic abnormalities . Compared with patients with dengue infection who did not have myocarditis, myocarditis was associated with a longer hospital stay and increased mortality .…”

Section: Methodsmentioning

confidence: 99%

“…Dengue-associated acute myocarditis has been reported in 4% to 7% of hospitalized patients with dengue from Pakistan and India, based on troponin increase and echocardiographic abnormalities . Compared with patients with dengue infection who did not have myocarditis, myocarditis was associated with a longer hospital stay and increased mortality . Severe dengue is characterized by bleeding, and plasma leakage from capillaries resulting in cardiovascular shock, and manifestations that can overlap with acute myocarditis .…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 82% to 95% of patients with myocarditis reported chest pain, 19% to 49% reported dyspnea, 58% to 65% developed fever, and 5% to 7% experienced syncope . Cardiogenic shock occurred in about 3% to 9% of patients with acute myocarditis (ie, fulminant myocarditis) (Table 1) …”

Section: Methodsmentioning

confidence: 99%

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Diagnosis and Treatment of Acute Myocarditis

Ammirati

Moslehi

2023

JAMA

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ImportanceAcute myocarditis, defined as a sudden inflammatory injury to the myocardium, affects approximately 4 to 14 people per 100 000 each year globally and is associated with a mortality rate of approximately 1% to 7%.ObservationsThe most common causes of myocarditis are viruses, such as influenza and coronavirus; systemic autoimmune disorders, such as systemic lupus erythematosus; drugs, such as immune checkpoint inhibitors; and vaccines, including smallpox and mRNA COVID-19 vaccines. Approximately 82% to 95% of adult patients with acute myocarditis present with chest pain, while 19% to 49% present with dyspnea, and 5% to 7% with syncope. The diagnosis of myocarditis can be suggested by presenting symptoms, elevated biomarkers such as troponins, electrocardiographic changes of ST segments, and echocardiographic wall motion abnormalities or wall thickening. Cardiac magnetic resonance imaging or endomyocardial biopsy are required for definitive diagnosis. Treatment depends on acuity, severity, clinical presentation, and etiology. Approximately 75% of patients admitted with myocarditis have an uncomplicated course, with a mortality rate of approximately 0%. In contrast, acute myocarditis that is complicated by acute heart failure or ventricular arrhythmias is associated with a 12% rate of either in-hospital mortality or need for heart transplant. Approximately 2% to 9% of patients have hemodynamic instability, characterized by inability to maintain adequate end-organ perfusion, and require inotropic agents, or mechanical circulatory devices, such as extracorporeal life support, to facilitate functional recovery. These patients have an approximately 28% rate of mortality or heart transplant at 60 days. Immunosuppression (eg, corticosteroids) is appropriate for patients who have myocarditis characterized by eosinophilic or giant cell myocardial infiltrations or due to systemic autoimmune disorders. However, the specific immune cells that should be targeted to improve outcomes in patients with myocarditis remain unclear.Conclusions and RelevanceAcute myocarditis affects approximately 4 to 14 per 100 000 people per year. First-line therapy depends on acuity, severity, clinical presentation, and etiology and includes supportive care. While corticosteroids are often used for specific forms of myocarditis (eg, eosinophilic or giant cell infiltrations), this practice is based on anecdotal evidence, and randomized clinical trials of optimal therapeutic interventions for acute myocarditis are needed.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Diagnosis and Treatment of Acute Myocarditis

Ammirati

Moslehi

2023

JAMA

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“…No entanto, ainda não existem estudos robustos correlacionando a utilização de biomarcadores com o prognóstico da infecção ou o grau da lesão cardíaca por dengue. Portanto, as enzimas devem ser incluídas na investigação diagnóstica, quando possível, de forma complementar, mas não como único instrumento diagnóstico, devido à baixa especificidade de certos marcadores e à limitação do seu uso em centros de saúde primários ou secundários, os quais, em grande parte, não possuem a disponibilidade de exames laboratoriais mais complexos (Baqi et al, 2022).…”

Section: Diagnósticounclassified

Envolvimento cardíaco na infecção por Dengue - uma revisão abrangente sobre fisiopatologia, epidemiologia, manifestações clínicas, diagnóstico e tratamento

Silva,

Trindade,

Pinto

et al. 2024

Braz. J. Hea. Rev.

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O envolvimento cardíaco na infecção por dengue é uma complicação complexa e multifacetada que merece atenção especial devido às suas implicações significativas na morbidade e mortalidade dos pacientes afetados. A fisiopatologia desta condição é caracterizada por uma resposta inflamatória descontrolada desencadeada pelo vírus da dengue, que pode levar a uma série de alterações no sistema cardiovascular. Em termos de epidemiologia, estudos têm demonstrado uma associação significativa entre a gravidade da infecção por dengue e o envolvimento cardíaco. Em áreas endêmicas, onde a prevalência da doença é alta, casos de dengue com complicações cardíacas são mais comuns, destacando a importância da vigilância ativa e do manejo precoce para evitar complicações graves. As manifestações clínicas podem variar consideravelmente, desde sintomas leves, como palpitações e dispneia, até complicações potencialmente fatais, como choque cardiogênico e insuficiência cardíaca aguda. Além disso, arritmias cardíacas, pericardite e miocardite também podem ocorrer. O diagnóstico preciso dessas manifestações muitas vezes requer uma abordagem multidisciplinar, incluindo exames clínicos minuciosos, avaliação laboratorial de biomarcadores cardíacos e exames de imagem, como ecocardiografia. O tratamento é baseado principalmente em medidas de suporte e controle dos sintomas. Isso inclui a administração cuidadosa de líquidos para manter a perfusão adequada dos órgãos, controle da pressão arterial e suporte ventilatório, quando necessário. Em casos mais graves, intervenções específicas podem ser necessárias, como o uso de agentes inotrópicos e vasopressores para otimizar a função cardíaca. Além disso, em situações selecionadas, a administração de corticosteróides e imunoglobulinas intravenosas pode ser considerada para modular a resposta inflamatória. Por fim, a identificação precoce dos sintomas, o diagnóstico preciso e a implementação de medidas terapêuticas adequadas são fundamentais para melhorar os desfechos clínicos e reduzir o impacto negativo dessa complicação potencialmente grave.

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