Myocarditis in a Traveler Returning from the Dominican Republic: An Unusual Presentation of Dengue Fever

Zea, Diego; Foley, Kimberly; Carey, Jeanne

doi:10.4269/ajtmh.13-0637

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…140 Severe disease outcomes other than dengue shock syndrome: Although vascular leakage is the hallmark of severe dengue, other unsuual severe complications can also occur. Unusual complications include myocarditis 141 , other cardiac problems 87,141,142 and fulminant hepatitis. 143 Dengue can manifest with a wide range of neurological features, which have been noted in 0.5-21% of patients with dengue admitted to hospital.…”

Section: Clinical Manifestations Of Severe Dengue and Managementmentioning

confidence: 99%

Severe dengue in travellers: pathogenesis, risk and clinical management

Halstead

Wilder‐Smith

2019

Journal of Travel Medicine

102

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Rationale for review Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. Risk, pathogenesis and clinical management The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2–4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. Conclusions Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.

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Section: Clinical Manifestations Of Severe Dengue and Managementmentioning

confidence: 99%

Severe dengue in travellers: pathogenesis, risk and clinical management

Halstead

Wilder‐Smith

2019

Journal of Travel Medicine

102

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“…Literature to support the existence of myocarditis in dengue infection has been available for more than a decade [8–15]. However, clinical management guidelines have given only little importance to myocarditis as a manifestation in dengue infection [6, 15].…”

Section: Discussionmentioning

confidence: 99%

“…Histopathological evidence of myocarditis was also found in 2009 [13]. A traveler returning from the Dominican Republic developing myocarditis has been published in 2014 [8]. Even though, there have been many deaths due to dengue, the literature available on necropsy studies dealing with detection of virus in tissues and related histopathology is scarce [16–21].…”

Section: Discussionmentioning

confidence: 99%

Heart and liver are infected in fatal cases of dengue: three PCR based case studies

et al. 2018

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BackgroundDengue is a global problem mainly in the tropics. Meticulous clinical management of cases has reduced the death rate significantly, but large numbers of people still succumb to severe complications of the infection. Presence of myocarditis is often overlooked leading to a poor outcome. Clinical management guidelines of dengue do not stress the importance of myocarditis as a manifestation in dengue infection. Severe hepatic dysfunction also needs emphasis.Case presentationWe present three patients who had come to hospital on the 3rd day of fever. Two of them (case 1 and 3) were in shock on admission and case 2, who was stable on the3rd day, went into the critical phase and developed shock while in the hospital on the 4thday. All three had tachycardia on admission that got worse with time. The clinical course was unstable with fluctuations in urine output and deterioration of organ function. Despite frequent monitoring and life support they survived only 2–3 days in hospital. All three patients had myocarditis during the critical phase. In the first case, myocarditis was confirmed by troponin estimation and echocardiogram. In the second and third cases, histopathology confirmed myocarditis. Haemorrhagic necrosis of the liver was found in case 2 and 3 with exponential rise of transaminases. In all three cases, viral RNA was detected in both heart and liver tissues by PCR amplification.ConclusionsWe stress that detection of myocarditis and liver involvement in any dengue patient is important from the onset of the illness where treatment should be tailored to prevent development of hypotension. Our findings are novel as PCR and histology are rarely done on tissues of deceased dengue patients in the world. Studies are needed to find therapeutic interventions to reverse cardiac and hepatic dysfunction in dengue infection.

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“…Arora y cols, (7) observaron anormalidad del ritmo cardíaco en 15,8 % de 120 pacientes con dengue y de estos, 37,5 % tuvieron miocarditis. Zea y cols, (21), describen un caso de un paciente adulto con dengue que desarrolla miocarditis con bloqueo de rama izquierda. En el presente estudio ningún paciente tuvo diagnóstico de miocarditis, sin embargo, síntomas como bradicardia, hipotensión y taquicardia fueron encontrados en 15,4 %, 12,8 % y 23,1 % de los pacientes respectivamente.…”

Section: Discussionunclassified

Actividad en suero de CK y CK-MB en pacientes con infección por el virus dengue

Agudelo-Salas¹,

Quinceno

Duque³

et al. 2017

Rev. salud pública

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In this study, no patient with dengue infection had heart disease or myositis; however, the finding of a higher frequency of elevated level CK and CK-MB in the dengue patients compared to the control group suggests the involvement of the striated muscle and of the cardiac muscle in this group. For this reason, the monitoring of these enzymes should be considered as part of the monitoring of patients with dengue.

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Myocarditis in a Traveler Returning from the Dominican Republic: An Unusual Presentation of Dengue Fever

Cited by 12 publications

References 11 publications

Severe dengue in travellers: pathogenesis, risk and clinical management

Severe dengue in travellers: pathogenesis, risk and clinical management

Heart and liver are infected in fatal cases of dengue: three PCR based case studies

Actividad en suero de CK y CK-MB en pacientes con infección por el virus dengue

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