Dengue myocarditis in Singapore: two case reports

Marques, Nuno; Gan, Victor C.; Leo, Yee‐Sin

doi:10.1007/s15010-012-0392-9

Cited by 34 publications

(24 citation statements)

References 20 publications

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“…Their conditions improved during outpatient care and all four were also clinically stable throughout the entire course of illness. There was a single mortality, previously published as a case report [13]. He was admitted because of loss of appetite, severe vomiting, nausea, malaise, mild headaches and dizziness.…”

Section: Resultsmentioning

confidence: 99%

“…The window to provide intervention can be challenging in areas where healthcare facilities are remote from place of residence. We reported a single fatality that had WS one day before his death, highlighting the possible rapid progression of dengue disease [13]. With regard to mucosal bleeding as the most frequent WS, its frequency was not statistically different between the DF and DHF patients.…”

Section: Discussionmentioning

confidence: 99%

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Utility of warning signs in guiding admission and predicting severe disease in adult dengue

Leo

Gan

et al. 2013

BMC Infect Dis

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BackgroundThe recommendation from the 2009 World Health Organization guidelines for managing dengue suggests that patients with any warning sign can be hospitalized for observation and management. We evaluated the utility of using warning signs to guide hospital admission and predict disease progression in adults.MethodsWe conducted a prospective cohort study from January 2010 to September 2012. Daily demographic, clinical and laboratory data were collected from adult dengue patients. Warning signs were recorded. The proportion of admitted patients using current admission criteria and warning signs was compared. The sensitivity, specificity, positive and negative predictive values of warning signs in predicting disease progression were also evaluated.ResultsFour hundred and ninety-nine patients with confirmed dengue were analyzed. Using warning signs instead of the current admission criteria will lead to a 44% and 31% increase in admission for DHF II-IV and SD cases respectively. The proportion of non-severe dengue cases which were admitted also increased by 32% for non DHF II-IV and 33% for non-SD cases. Absence of any warning signs had a NPV of 91%, 100% and 100% for DHF I-IV, DHF II-IV and SD. Of those who progressed to severe illness, 16.3% had warning signs on the same day while 51.3% had warning signs the day before developing severe illness, respectively.ConclusionsOur findings demonstrated that patients without any warning signs can be managed safely with ambulatory care to reduce hospital resource burden. No single warning sign can independently predict disease progression. The window from onset of warning sign to severe illness in most cases was within one day.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utility of warning signs in guiding admission and predicting severe disease in adult dengue

Leo

Gan

et al. 2013

BMC Infect Dis

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“…Cardiac and acute kidney injury have been documented after DENV infection. [36][37][38][39][40] However, biochemical changes were seen after primary DENV infection in the absence of DHF/dengue shock syndrome (DSS). Acute injury Infection of liver tissues and DENV-mediated liver damage has been reported extensively.…”

Section: Discussionmentioning

confidence: 99%

Serotype-Specific Host Responses in Rhesus Macaques after Primary Dengue Challenge

Hickey

Koster²,

Thalmann

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Dengue virus (DENV) is considered to be the most important arthropod-borne viral disease and causes more than 100 million human infections annually. To further characterize primary DENV infection in vivo, rhesus macaques were infected with DENV-1, DENV-2, DENV-3, or DENV-4 and clinical parameters, as well as specificity and longevity of serologic responses, were assessed. Overt clinical symptoms were not present after infection. However, abnormalities in blood biochemical parameters consistent with heart, kidney, and liver damage were observed, and changes in plasma fibrinogen, D-dimers, and protein C indicated systemic activation of the blood coagulation pathway. Significant homotypic and heterotypic serum immunoglobulins were present in all animals, and IgG persisted for at least 390 days. Serum neutralizing antibody responses were highly serotype specific by day 120. However, some heterotypic neutralizing activity was noted in infected animals. Identification of serotype-specific host responses may help elucidate mechanisms that mediate severe DENV disease after reinfection.

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“…Dilated cardiomyopathy of any cause, arrhythmogenic right ventricular cardiomyopathy, idiopathic giant cell myocarditis, lymphocytic myocarditis, connective tissue diseases, vasculitis (Takayasu arteritis and Wegener granulomatosis), amyloidosis, dengue fever, Chagas disease, and other infectious causes like rheumatic fever, syphilis, fungal infections, and tuberculosis should be considered in the differential diagnosis of CS (33,50,82,(101)(102)(103)(104)(105)(106)(107)(108)(109)(110)(111).…”

Section: Differential Diagnosismentioning

confidence: 99%