Dengue myocarditis, rare but not fatal manifestation

Abstract

Dengue infection is an important mosquito-borne infectious disease. This disease is common in the tropical countries, especially Southeast Asian countries. A severe form of dengue infection called dengue hemorrhagic fever (DHF) requires hospitalization. Thrombocytopenia and hemoconcentration are the hallmark of the DHF. The cardiac complications in DHF are not common. There are only a few reports concerning the magnitude and pattern of cardiac manifestation among severe DHF cases. Myocarditis is the most common cardiac pathology in dengue infection; however, there have been only a few reported cases of dengue myocarditis in the world literature [1]. Here, the author summarized the previous reports on Thai cases with dengue myocarditis and studied the magnitude of dengue myocarditis in the autopsy reports of fatal Thai DHF cases. A literature review on the papers concerning dengue myocarditis among the Thais was performed from database of the published works cited in the Index Medicus and Science Citation Index and also the published works in all 256 local Thai journals, which are not included in the international citation index. Similar search was performed to search for the paper reporting the autopsy reports of fatal Thai DHF cases. The reports that contained no complete data were excluded for further analysis. According to the review, there were only 2 reports [2,3] covering 2 cases of dengue myocarditis among the Thais. Both cases are male pediatric DHF patients, aged 12 [3] and 13 [2] years, respectively. Both developed bradycardia and hypotension a day after recovery from DHF and electrocardiogram, of which during bradycardia, showed a junctional rhythm [2,3]. Both were diagnosed early and treated with intravenous hydrocortisone and had complete recovery [2,3]. Of interest, although there are thousands of DHF in