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Histopathological diagnosis of myocarditis in a dengue outbreak in Sri Lanka, 2009
Kosala Gad Weerakoon1, Senanayake Am Kularatne, Deepthika H Edussuriya
1Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka. samkul@sltnet.lk.
Insights
Histopathological analysis of 5 fatal dengue cases in Sri Lanka confirmed myocarditis. Dengue infection can lead to severe cardiac inflammation and damage, impacting other organs.
Area of Science:
- Pathology
- Infectious Diseases
- Cardiology
Background:
- A severe dengue outbreak in Sri Lanka in 2009 resulted in high mortality.
- Myocarditis was clinically suspected in a significant portion of dengue fever patients.
Purpose of the Study:
- To histopathologically examine the hearts and other organs of patients who died from suspected dengue-associated myocarditis.
- To elucidate the cardiac pathology in severe dengue infections.
Main Methods:
- Autopsies were performed on 5 patients with clinically suspected myocarditis during the 2009 dengue outbreak.
- Dengue diagnosis was confirmed using serological (IgM/IgG ELISA, HAI) and molecular (RT-PCR) methods.
- Histological examination of tissue sections was conducted using hematoxylin and eosin staining.
Main Results:
- Of 319 dengue cases, 166 (52%) were severe, with 149 (90%) having secondary dengue infection; DEN-1 was identified in 5 cases.
- Autopsies revealed interstitial edema, inflammatory cell infiltration, and myocardial fiber necrosis in all 5 patients, consistent with myocarditis.
- Concurrent findings included pleural effusions, ascites, bleeding, pericarditis, pulmonary abnormalities, and liver necrosis in some cases.
Conclusions:
- Histopathological findings strongly support the occurrence of myocarditis in dengue infection.
- Dengue virus infection can lead to significant cardiac pathology, including myocardial damage and inflammation.
Background:
In 2009, an outbreak of dengue caused high fatality in Sri Lanka. We conducted 5 autopsies of clinically suspected myocarditis cases at the General Hospital, Peradeniya to describe the histopathology of the heart and other organs.
Methods:
The diagnosis of dengue was confirmed with specific IgM and IgG ELISA, HAI and RT-PCR techniques. The histology was done in tissue sections stained with hematoxylin and eosin.
Results:
Of the 319 cases of dengue fever, 166(52%) had severe infection. Of them, 149 patients (90%) had secondary dengue infection and in 5 patients, DEN-1 was identified as the causative serotype. The clinical diagnosis of myocarditis was considered in 45(27%) patients. The autopsies were done in 5 patients who succumbed to shock (3 females and 2 males) aged 13- 31 years. All had pleural effusions, ascites, bleeding patches in tissue planes and histological evidence of myocarditis. The main histological findings of the heart were interstitial oedema with inflammatory cell infiltration and necrosis of myocardial fibers. One patient had pericarditis. The concurrent pulmonary abnormalities were septal congestion, pulmonary haemorrhage and diffuse alveolar damage; one case showed massive necrosis of liver.
Conclusions:
The histology supports occurrence of myocarditis in dengue infection.
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