Brief report. Hepatic dysfunction in childhood dengue infection

Abstract

Hepatic functions of 61 children, diagnosed to have dengue infection (DI), aged 2 months to 12 years comprising 37 cases of dengue fever (DF), 16 with dengue hemorrhagic fever (DHF), and eight with dengue shock syndrome (DSS) were prospectively studied during the acute attack. Hepatomegaly (74 per cent), epistaxis (26 per cent), jaundice (25 per cent), and petechial rashes (18 per cent) were the common clinical manifestations of DI. On admission, levels of serum aspartate transaminase (AST), serum alanine transaminase (ALT) and serum alkaline phosphatase (AP) were raised in 80-87 per cent of children with hepatomegaly (group I) and 81 per cent of cases without hepatomegaly (group II). During the second week of hospitalization the proportion of cases with raised levels of AST, ALT, AP and serum bilirubin increased and the mean levels were significantly higher (p < 0.05) in both the groups. These levels gradually declined over the next 2-3 weeks. All the cases with DSS and DHF had raised AST, ALT and AP levels and the mean levels of these enzymes were significantly higher (p < 0.05) as compared to DF. Our results suggest a transient derangement of liver functions in childhood DI, more so in DSS and DHF, with or without hepatomegaly.

The impact of dengue on liver function as evaluated by aminotransferase levels

“…The reduction in serum globulin is an important factor in fluid loss into the third space, which is indicative of severity in dengue due to a reduction in the gradient of intra-and extravascular pressure. These findings have been confirmed by other authors in cases of hepatitis in dengue shock syndrome [10,12]. Therefore, AST, ALT and globulin are valuable parameters for the evaluation of the severity of the infection.…”

“…The extent to which the liver is affected by DENV ranges from mild lesions to fulminant hepatitis [5,[9][10][11][12][13].…”

Morphological studies in a model for dengue-2 virus infection in mice

“…The analysis of the liver tissue showed extensive cell cytopathic effects as vacuolization and intracellular edema; the architecture of the hepatic lobules was partially destroyed; sinusoids were partially collapsed; only a minimal and diffusely distributed mononuclear inflammatory infiltrate was visible; blood vessels were dilated; In humans, DENV has been frequently isolated from the liver, and the antigens have been detected in Kupffer cells and hepatocytes (Rosen et al 1989, Bhamarapravati 1997, Couverland et al 1999. Liver function tests showed high levels of serum aspartate transaminase (AST) and serum alanine transaminase (ALT) activity, indicating hepatic injury (Kuo et al 1992, Nguyen et al 1997, Mohan et al 2000. Histologically the most common features in the liver were small foci of necrosis and microvesicular steatosis (Bhamarapravati et al 1967, Burke 1968, Fresh et al 1969.…”

“…Liver function tests showed high levels of serum aspartate transaminase (AST) and serum alanine transaminase (ALT) activity, indicating hepatic injury (Kuo et al 1992, Nguyen et al 1997, Mohan et al 2000. Histologically the most common features in the liver were small foci of necrosis and microvesicular steatosis (Bhamarapravati et al 1967, Burke 1968, Fresh et al 1969.…”

É possível identificar a dengue em crianças a partir do critério de caso suspeito preconizado pelo Ministério da Saúde?

“…Cases with positive IgM for a single sample would be probable dengue cases since the finding can persist for up to 90 days. Despite this, probable and confirmed cases have been analyzed in conjunction in some studies 14,26,27 and the Health Ministry defines confirmed cases of dengue as those in which IgM is positive in association with indicative clinical and epidemiological status. 3 According to that definition, around 50% of the children with acute nonspecific febrile diseases had dengue.…”