Is dengue emerging as important cause of acute liver failure in endemic regions?

Abstract

Dengue virus infection continues to be major public health problem in large part of world. The epidemiology of dengue viral infection is becoming increasingly complex and has substantially changed over almost past six decades not only in terms of prevalent strains and geographical locations but also in terms of disease severity and atypical presentations. Though liver is the most common organ affected but is generally asymptomatic. We present a case of infant with severe dengue who died of fulminant hepatic failure and showed pan lobular necrosis on post mortem liver biopsy. The case is being presented to highlight life threatening complication of dengue in young children, and dengue viral infection as a cause of acute liver failure in endemic areas. Thus dengue fever should also be considered as one of the differential diagnosis in children presenting with fever and fulminant hepatic failure in endemic regions.

Metabolomic Insights into Human Arboviral Infections: Dengue, Chikungunya, and Zika Viruses

“…Confirming the link between liver damage and certain metabolites, Cui et al [25,93] found elevated liver transaminases correlated with elevated bile acids. Acceptance that DENVs cause liver damage is gaining traction [107,108], though the sensitivity of metabolomic findings suggests earlier mild damage than previously appreciated.…”

Clinical and Laboratory Characteristics of Hemophagocytic Lymphohistiocytosis in Children With Severe Dengue During the 2019–2020 Outbreak in Southern Colombia

“…This is a rare condition with high mortality, 53 and has been described in dengue since 1980. 54,55 Ultimately, HLH was shown to be a form of presentation in children with severe dengue, who more frequently showed splenomegaly, bacterial coinfection, anemia, transaminase levels >1000 U/L and LDH >1000 U/L. These patients also presented with more multiorgan involvement, as evidenced by a higher proportion of subjects with myocarditis and hepatitis.…”

Falla hepática aguda inducida por dengue

“…Así mismo, el paciente desarrolló falla hepática aguda (FHA) por dengue, patología que aunque es infrecuente tiene alta mortalidad, no sólo por alteración en las funciones de síntesis y de detoxificación, sino porque refleja una respuesta inflamatoria severa frente a la infección (6). En la práctica, aparte del uso de medicamentos y algunos virus hepatotropos, el dengue debería ser considerado como un diagnóstico diferencial de FHA en los países de alta endemicidad como Colombia, por el incremento considerable de su prevalencia en las últimas décadas debido a las malas condiciones de higiene y el cambio climático (2,7).…”