Histopathological study of Dengue Haemorrhagic Fever

Abstract

Introduction: Dengue Haemorrhagic Fever (DHF) is a severe febrile disease caused by a Flavivirus.Four serotypes of dengue virus (DEN 1-4) are present and the large majority of DHF occurs following a secondary infection with a different serotype. About 0.5 million people in the world develop DHF annually with 24,000 deaths. Pathogenesis of the disease is still not fully understood. Target cells include dendritic reticulum cells, monocytes, lymphocytes, hepatocytes, and vascular endothelial cells. Objectives: To describe the histopathological changes in the liver, lungs, heart, brain, spleen, gastrointestinal tract and kidneys in fatal DHF. Materials and methods: Tissue from seventeen autopsies following DHF were processed routinely and stained with haematoxylin and eosin. Histopathological changes in the liver, lungs, heart, brain, spleen, gastrointestinal tract and kidneys were studied. Results: Fifteen of 17 cases showed a liver pathology which included submassive necrosis (1/15), bridging necrosis (2/15), midzonal (3/15) and centrilobular necrosis (4/15), focal necrosis (2/15), apoptosis (1/15) and macrovesicular steatosis (7/15). Pulmonary haemorrhage was present in 13cases and pulmonary oedema in 6 cases. Glomerular congestion and haemorrhage were seen in 6 and medullary congestion with haemorrhage was present in 9 cases. Gastrointestinal mucosal haemorrhages were seen in 8. One patient showed myocarditis and one showed myocardial haemorrhages.Cerebral oedema was present in 8 cases In 13 out of 17 cases the spleen showed red pulp congestion and haemorrhage. Conclusion:DHF is a systemic viral infection causing multiorgan pathology. Liver, lungs and spleen are the most commonly affected organs.

Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement

“…Dilatation of subpleural lymphatic spaces, alveolar congestion, septal hemorrhage, acute DAH (Fig. 4), and pleural effusion have been reported in association with SD [12,14,41,42,47,48]. Extensive lung involvement in fatal cases of dengue, especially in association with lung hemorrhage, is a terminal event and is probably associated with uncontrolled infection and shock [38].…”

“…DSS is reported to be the third leading cause of ARDS in dengue-endemic areas [11,12,41]. Thus, especially in the setting of a dengue epidemic, the presence of DF should be investigated in patients with ARDS [42].…”

“…DHF should be regarded as a multiorgan infection, and the lungs are invariably affected [42]. Pulmonary pathological findings in autopsy studies of dengue cases, particularly those of SD, are mononuclear inflammatory infiltrates, hyperplasia of alveolar macrophages, and hyaline membrane formation with hypertrophy of type II pneumocytes.…”

Hallazgos postmortem en infección por el virus del dengue

“…La necrosis predomina en la zona 1,2 y en región periportal (9-22). Se observa micro y macroesteatosis (9, [11][12][13][14][15][16][17]19,21,22 No se encuentra correlación entre la cantidad de RNA viral y la extensión de la necrosis hepática, pero sí se una correlación positiva con el grado de hiperplasia de células de Kupffer y la cantidad de carga viral. Este hallazgo sería el esperado, ya que estas células tienen la función macrofagocitica del hígado y serían las encargadas de la producción de citoquinas proinflamatorias en respuesta a esta infección (31).…”

“…En el bazo los hallazgos más comunes son congestión, hemorragias y atrofia de folículos linfoides, infiltrados de mononucleares, necrosis y esplenitis aguda (10, 13,14,19,20,22,24,28). Hay presencia de antígeno viral en macrófagos circulantes de la pulpa roja, células multinucleadas y linfoides (22).…”