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Research article
Chayasin Mansanguan
Mahidol University Faculty of Tropical Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7852-626X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Dengue virus infection (DVI) is a major health problem in many parts of the world. Its manifestations range from asymptomatic infections to severe disease. Although cardiac involvement has been reported in DVI, its incidence has not yet been well established.
Methods
From July 2016 to January 2018, patients hospitalized at the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, with dengue virus infection confirmed by positive NS1 or positive dengue immunoglobulin M findings, participated in the study. We characterized the incidence and change in cardiac function by serial echocardiography and levels of troponin-T and creatinine kinase-myocardial band (CK-MB) on the day of admission, the day of defervescence, the first day of hypotension (if any), and at 2-week follow-up.
Results
Of the 81 patients evaluated, 6 (7.41%) exhibited elevated biomarker levels. There was no difference in clinical presentation amongst dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) except the amount of bleeding. Cardiac involvement was found in 22% of patients: 3 (3.70%) had left ventricular systolic dysfunction, 3 (3.70%) had transient diastolic dysfunction, 6 (7.41%) had increased levels of at least one cardiac biomarker (troponin-T or CK-MB), and 6 (7.41%) had small pericardial effusion. Myocarditis was suspected in only two patient (with DHF); thus, myocarditis was uncommon in patients with dengue virus infection. Three patients developed DSS during admission and transfer to the intensive care unit.
Conclusion
Cardiac involvement in adults with dengue infection was found in 22.22% of cases, ranging from elevated cardiac biomarker, transient left ventricular systolic and diastolic dysfunction and pericardial effusion. We found that DHF was the significant risk factor for cardiac involvement (p < 0.001). Abnormalities in cardiac function had resolved spontaneously by the day of follow-up without specific treatment.
Keywords
Dengue infection, cardiac involvement, serial echocardiography
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 1
Posted 28 May, 2020
No community comments so far
Editorial decision: Major revision
On 29 Dec, 2020
Review #2 received
Received 21 Dec, 2020
Review #1 received
Received 27 Aug, 2020
Reviewer #2 agreed
On 18 Jul, 2020
Reviewers invited
Invitations sent on 16 Jun, 2020
Reviewer #1 agreed
On 16 Jun, 2020
First submitted
On 21 May, 2020
Editor assigned
On 21 May, 2020
Submission checks complete
On 20 May, 2020
Editor invited
On 20 May, 2020
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Subject Areas
Infectious Diseases
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A new preprint design is coming!
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Chayasin Mansanguan
Mahidol University Faculty of Tropical Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7852-626X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 1
Posted 28 May, 2020
No community comments so far
Editorial decision: Major revision
On 29 Dec, 2020
Review #2 received
Received 21 Dec, 2020
Review #1 received
Received 27 Aug, 2020
Reviewer #2 agreed
On 18 Jul, 2020
Reviewers invited
Invitations sent on 16 Jun, 2020
Reviewer #1 agreed
On 16 Jun, 2020
First submitted
On 21 May, 2020
Editor assigned
On 21 May, 2020
Submission checks complete
On 20 May, 2020
Editor invited
On 20 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background
Dengue virus infection (DVI) is a major health problem in many parts of the world. Its manifestations range from asymptomatic infections to severe disease. Although cardiac involvement has been reported in DVI, its incidence has not yet been well established.
Methods
From July 2016 to January 2018, patients hospitalized at the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, with dengue virus infection confirmed by positive NS1 or positive dengue immunoglobulin M findings, participated in the study. We characterized the incidence and change in cardiac function by serial echocardiography and levels of troponin-T and creatinine kinase-myocardial band (CK-MB) on the day of admission, the day of defervescence, the first day of hypotension (if any), and at 2-week follow-up.
Results
Of the 81 patients evaluated, 6 (7.41%) exhibited elevated biomarker levels. There was no difference in clinical presentation amongst dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) except the amount of bleeding. Cardiac involvement was found in 22% of patients: 3 (3.70%) had left ventricular systolic dysfunction, 3 (3.70%) had transient diastolic dysfunction, 6 (7.41%) had increased levels of at least one cardiac biomarker (troponin-T or CK-MB), and 6 (7.41%) had small pericardial effusion. Myocarditis was suspected in only two patient (with DHF); thus, myocarditis was uncommon in patients with dengue virus infection. Three patients developed DSS during admission and transfer to the intensive care unit.
Conclusion
Cardiac involvement in adults with dengue infection was found in 22.22% of cases, ranging from elevated cardiac biomarker, transient left ventricular systolic and diastolic dysfunction and pericardial effusion. We found that DHF was the significant risk factor for cardiac involvement (p < 0.001). Abnormalities in cardiac function had resolved spontaneously by the day of follow-up without specific treatment.
Figure 1
Figure 2
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