Histopathological diagnosis of myocarditis in a dengue outbreak in Sri Lanka, 2009

Kosala Gad Weerakoon,Vasanti G Pinto,Sunethra Gunasena,Sarachchandra Ka Kodikara,Ashoka B Seneviratne,Senanayake Am Kularatne,Laxman Pg Gunatilake,Deepthika H Edussuriya

doi:10.1186/1756-0500-4-268

Abstract

BackgroundIn 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.MethodsThe 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.ResultsOf 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.ConclusionsThe histology supports occurrence of myocarditis in dengue infection.

Highlights

In 2009, an outbreak of dengue caused high fatality in Sri Lanka
Dengue virus infection is widely distributed in the tropical and subtropical regions of the globe affecting up to 100 million people per year; 2.5 billion people are at risk [1]
Dengue virus infections cause a spectrum of illnesses ranging from self-limiting fever to severe dengue haemorrhagic fever(DHF) where increased vascular permeability is the main pathology leading to shock [1,2,3]

Summary

Introduction

We conducted 5 autopsies of clinically suspected myocarditis cases at the General Hospital, Peradeniya to describe the histopathology of the heart and other organs. Dengue virus infection is widely distributed in the tropical and subtropical regions of the globe affecting up to 100 million people per year; 2.5 billion people are at risk [1]. Dengue virus infections cause a spectrum of illnesses ranging from self-limiting fever to severe dengue haemorrhagic fever(DHF) where increased vascular permeability is the main pathology leading to shock [1,2,3]. Uncommon complications such as acute hepatic failure, acute renal failure, dengue encephalitis and myocarditis have been recognized [4,5,6,7]. Many viruses cause myocarditis and their pathogenesis has been described in the literature.

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Conclusion