Cardiovascular complications associated with Dengue Virus infection
DOI:
https://doi.org/10.34119/bjhrv7n9-219Keywords:
cardiovascular complications, Dengue, viral infectionAbstract
The present study addressed the cardiovascular complications arising from dengue virus (DENV) infection. Dengue is a disease transmitted by mosquitoes of the species Aedes aegypti. This disease can range from mild to severe, being classified into four categories: A (without warning signs), B (with warning signs), C (severe), and D (complicated). DENV infection can provoke an intense inflammatory response, increased vascular permeability, and direct damage to cardiomyocytes. This can lead to various cardiovascular complications, including myocarditis, pericarditis, and cardiomyopathies. The critical phase of dengue is marked by cardiovascular symptoms such as hypotension, cardiac rhythm disturbances, and signs of heart failure. Studies in animal models have shown that DENV infection results in systemic inflammation, increased vascular permeability, reduced blood pressure, and alterations in cardiac function. The association between preexisting cardiovascular diseases and severe dengue infection is complex, increasing the risk of severe complications. Dengue treatment is mainly symptomatic, involving hydration and the use of analgesics, with intensive support measures in severe cases. Early identification and adequate treatment of cardiovascular complications are essential to improve clinical outcomes. Therefore, it can be concluded that dengue represents a significant challenge to public health, especially in endemic regions. Understanding the cardiovascular complications associated with DENV infection is crucial for the effective management of patients and for reducing mortality. Continuous research and epidemiological surveillance are essential to improve dengue prevention and treatment strategies, ensuring a better quality of life for affected patients.
References
ADAMS, C. D.; SYRO, D.; LLANO, J. F.; BETANCUR, J. F. Myocarditis: an uncommon manifestation of dengue fever infection. BMJ Case Rep., v. 14, n. 2, 2021.
ANTONIAK, S.; MACKMAN, N. Multiple roles of the coagulation protease cascade during virus infection. Blood, v. 123, n. 17, p. 2605-2613, 2014.
ARAIZA-GARAYGORDOBIL, D.; GARCÍA-MARTÍNEZ, C. E.; BURGOS, L. M.; SALDARRIAGA, C.; LIBLIK, K.; MENDOZA, I.; et al. Dengue and the heart. Cardiovasc J Afr., v. 32, n. 5, p. 276-283, 2021.
BAQI, A.; UR REHMAN, F.; MEMON, P. S.; OMAIR, S. F. Prevalence and outcomes of myocarditis in dengue-infected patients admitted to a tertiary care hospital of low-middle-income country. Glob Heart, v. 17, n. 1, 2022.
BARBOSA, S. M. P.; NOLÊTO, E. P.; JORGE, G. P. H.; DE FREITAS BRANCO, S. H. B.; PERES, V. N.; DA SILVA, G. M. T.; JOVILIANO, R. D. Correlação entre a infecção do vírus da dengue e suas consequências nas comorbidades cardíacas. Sete Editora, p. 436-443, 2023.
BHATT, M.; SONEJA, M.; FAROOQUI, F. A.; SINGLA, P.; VIKRAM, N. K.; BISWAS, A.; et al. Myocarditis in admitted patients with dengue fever. Infection, v. 48, p. 899-903, 2020.
BHATT, S.; GETHING, P. W.; BRADY, O. J.; MESSINA, J. P.; FARLOW, A. W.; MOYES, C. L.; et al. The global distribution and burden of dengue. Nature, v. 496, n. 7446, p. 504-507, 2013.
BICH, T. D.; PHAM, O. K. N.; HAI, D. H. T.; NGUYEN, N. M.; VAN, H. N.; WILLS, B.; YACOUB, S. A pregnant woman with acute cardiorespiratory failure: dengue myocarditis. Lancet, v. 385, n. 9974, p. 1260, 2015.
BISWAS, S.; KUMAR, P.; TANSIR, G.; BISWAS, A. Case report: cardiac tamponade in dengue hemorrhagic fever: an unusual manifestation of a common disease. Am J Trop Med Hyg., v. 101, n. 2, p. 448, 2019.
BUNTUBATU, S.; PRAWIROHARTONO, E. P.; ARGUNI, E. Myocarditis prevalence in pediatric dengue infection: a prospective study in a tertiary hospital in Yogyakarta, Indonesia. J Trop Pediatr., v. 65, n. 6, p. 603-608, 2019.
CABRERA-REGO, J. O.; ROJAS-QUIROZ, A. F.; VIDAL-TURREUELLES, Y.; YANES-QUINTANA, A. A. Manifestaciones cardiovasculares en pacientes hospitalizados con dengue. Enferm Infecc Microbiol Clin., v. 39, n. 3, p. 115-118, 2021.
CHOU, M.-T.; YU, W.-L. Takotsubo cardiomyopathy in a patient with dengue fever. Journal of the Formosan Medical Association, v. 115, n. 9, p. 818-9, 2016.
CORRÉ, J.; VALLY, S.; BOIRON, P.; BOUILLAUD, Y.; TRAVERS, J. Y. Spontaneous coronary hematoma concomitant with myocarditis: the first report of double cardiac complication of dengue. ESC Heart Fail., v. 10, n. 2, p. 1445-1448, 2023.
CRISTODULO, R.; LUOMA-OVERSTREET, G.; LEITE, F.; VACA, M.; NAVIA, M.; DURÁN, G.; et al. Dengue myocarditis: a case report and major review. Glob Heart, v. 18, n. 1, 2023.
DE ALMEIDA, R. R.; PAIM, B.; DE OLIVEIRA, S. A.; SOUZA, A. S.; GOMES, A. C. P.; ESCUISSATO, D. L.; et al. Dengue hemorrhagic fever: a state-of-the-art review focused on pulmonary involvement. Lung, v. 195, p. 389-395, 2017.
FARIAS, L. A. B. G.; BESERRA, F. L. C. N.; FERNANDES, L.; TEIXEIRA, A. A. R.; FERRAGUT, J. M.; GIRÃO, E. S.; PIRES, R. D. J. Myocarditis following recent chikungunya and dengue virus co-infection: a case report. Arq Bras Cardiol., v. 113, p. 783-786, 2019.
FARRUKH, A. M.; GANIPINENI, V. D. P.; JINDAL, U.; CHAUDHARY, A.; PUAR, R. K.; GHAZARIAN, K.; et al. Unveiling the dual threat: myocarditis in the spectrum of dengue fever. Curr Probl Cardiol., v. 49, n. 1 Pt A, 2024.
GUBLER, D. J. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev., v. 11, n. 3, p. 480-496, 1998.
GUPTA, S.; GUPTA, M.; KASHYAP, J. R.; ARORA, S. K. Early cardiovascular involvement in dengue fever: a prospective study with two-dimensional speckle tracking echocardiography. Trop Doct., v. 52, n. 2, p. 285-292, 2022.
JAYATHILAKA, P. G. N. S.; MENDIS, A. S. V.; PERERA, M. H. M. T. S.; DAMSIRI, H. M. T.; GUNARATNE, A. V. C.; AGAMPODI, S. B. An outbreak of leptospirosis with predominant cardiac involvement: a case series. BMC Infect Dis., v. 19, p. 1-8, 2019.
KANGUSSU, L. M.; COSTA, V. V.; OLIVON, V. C.; QUEIROZ-JUNIOR, C. M.; GONDIM, A. N. S.; MELO, M. B.; et al. Dengue virus infection induces inflammation and oxidative stress on the heart. Heart, v. 108, n. 5, p. 388-396, 2022.
KHONGPHATTHANAYOTHIN, A.; LERTSAPCHAROEN, P.; SUPACHOKCHAIWATTANA, P.; LA-ORKHUN, V.; KHUMTONVONG, A.; BOONLARPTAVECHOOKE, C.; PANCHAROEN, C. Myocardial depression in dengue hemorrhagic fever: prevalence and clinical description. Pediatr Crit Care Med., v. 8, n. 6, p. 524-529, 2007.
KULARATNE, S. A. M.; RAJAPAKSE, M. M.; RALAPANAWA, U.; WADUGE, R.; PATHIRAGE, L. P. M. M. K.; RAJAPAKSE, R. P. V. J. Heart and liver are infected in fatal cases of dengue: three PCR-based case studies. BMC Infect Dis., v. 18, n. 1, p. 1-6, 2018.
LEE, I. K.; LIU, J. W.; YANG, K. D. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations. PLoS Negl Trop Dis., v. 6, n. 2, 2012.
LI, Y.; HU, Z.; HUANG, Y.; LI, J.; HONG, W.; QIN, Z.; et al. Characterization of the myocarditis during the worst outbreak of dengue infection in China. Medicine, v. 95, n. 27, 2016.
LIN, T. C.; LEE, H. C.; LEE, W. H.; SU, H. M.; LIN, T. H.; HSU, P. C. Fulminant dengue myocarditis complicated with profound shock and fatal outcome under intra-aortic balloon pumping support. American Journal of Emergency Medicine, v. 33, n. 11, p. 1716-e1, 2015.
MADANAYAKE, P.; JAYAWARDENA, A.; WIJEKOON, S. L.; PERERA, N.; WANIGASURIYA, J. Fluid requirement in adult dengue hemorrhagic fever patients during the critical phase of the illness: an observational study. BMC Infectious Diseases, v. 21, n. 1, p. 286, 2021.
MAHESHWARI, D.; SAINI, K.; SINGH, P.; SINGLA, M.; NAYAK, K.; AGGARWAL, C. et al. Contrasting behavior between the three human monocyte subsets in dengue pathophysiology. iScience, v. 25, n. 6, 2022.
MANSANGUAN, C.; HANBOONKUNUPAKARN, B.; MUANGNOICHAROEN, S.; HUNTRUP, A.; POOLCHAROEN, A.; MANSANGUAN, S. et al. Cardiac evaluation in adults with dengue virus infection by serial echocardiography. BMC Infectious Diseases, v. 21, p. 1-13, 2021.
MAVES, R. C.; ORÉ, R. M. C.; PORTER, K. R.; KOCHEL, T. J. Immunogenicity and protective efficacy of a psoralen-inactivated dengue-1 virus vaccine candidate in Aotus nancymaae monkeys. Vaccine, v. 29, n. 15, p. 2691-6, 2011.
MEHTA, P.; HOTEZ, P. J. NTD and NCD co-morbidities: the example of dengue fever. PLoS Neglected Tropical Diseases, v. 10, n. 8, 2016.
MINISTRY OF HEALTH (BRAZIL). Dengue: diagnosis and clinical management. 6. ed. Brasília: Ministério da Saúde; 2024.
PADHI, B. K.; KHATIB, M. N.; GAIDHANE, S.; ZAHIRUDDIN, Q. S.; SATAPATHY, P.; RABAAN, A. A. et al. Association of cardiovascular disease with severe dengue: a systematic review and meta-analysis. Current Problems in Cardiology, 2023:102346.
PEREDA, M. G.; LOPEZ, M.; MARILUZ, M. Myocarditis and complicated dengue: a case report. Revista Chilena de Infectología, v. 32, n. 2, p. 238-9, 2015.
RAHIM, A.; HAMEED, A.; ISHAQ, U.; MALIK, J. M.; ZAIDI, S. M. J.; KHURSHID, H. et al. Cardiovascular sequelae of dengue fever: a systematic review. Expert Review of Cardiovascular Therapy, v. 20, n. 6, p. 465-79, 2022.
RAMDZAN, M. Y. M.; KHALID, K. F. M.; MOOD, M. C. Cardiogenic shock with complete heart block secondary to dengue myocarditis requiring temporary pacing. Cardiology in the Young, v. 32, n. 3, p. 494-6, 2022.
SAM, S. S.; OMAR, S. F.; TEOH, B. T.; ABD-JAMIL, J.; ABUBAKAR, S. Review of dengue hemorrhagic fever fatal cases seen among adults: a retrospective study. PLoS Neglected Tropical Diseases, v. 7, n. 5, 2013.
SATARASINGHE, R. L.; ARULTNITHY, K.; AMERASENA, N. L.; BULUGAHAPITIYA, U.; SAHAYAM, D. V. Asymptomatic myocardial involvement in acute dengue virus infection in a cohort of adult Sri Lankans admitted to a tertiary referral centre. British Journal of Cardiology, v. 14, n. 3, p. 171-3, 2007.
SENGUPTA, S. P.; NUGURWAR, A.; JAJU, R.; KHANDHERIA, B. K. Left ventricular myocardial performance in patients with dengue hemorrhagic fever and thrombocytopenia as assessed by two-dimensional speckle tracking echocardiography. Indian Heart Journal, v. 65, n. 3, p. 276-82, 2013.
SHIVANTHAN, M. C.; NAVINAN, M. R.; CONSTANTINE, G. R.; RAJAPAKSE, S. Cardiac involvement in dengue infection. Journal of Infection and Development Countries, v. 9, n. 04, p. 338-46, 2015.
SUGIANTO, N. A. Pathophysiology of dengue hemorrhagic fever. World Journal of Pharmaceutical Research, v. 10, n. 14, p. 218-23, 2021.
TANTAWICHIEN, T. Dengue fever and dengue hemorrhagic fever in adults. Southeast Asian Journal of Tropical Medicine and Public Health, v. 46, n. Suppl 1, p. 79-98, 2015.
TEYSSEYRE, L.; LEVY, Y.; RENOU, A.; VIDAL, C.; LARGHI, M.; BILAND, G. et al. Case report: Refractory shock due to fulminant dengue myocarditis treated with venoarterial extracorporeal membrane oxygenation: a report of four cases. American Journal of Tropical Medicine and Hygiene, v. 104, n. 2, p. 552, 2021.
WICHMANN, D.; KULARATNE, S.; EHRHARDT, S.; WIJESINGHE, S.; BRATTIG, N. W.; ABEL, W.; BURCHARD, G. D. Cardiac involvement in dengue virus infections during the 2004/2005 dengue fever season in Sri Lanka. Southeast Asian Journal of Tropical Medicine and Public Health, v. 40, n. 4, p. 727, 2009.
WORLD HEALTH ORGANIZATION (WHO). Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd ed. Geneva: World Health Organization; 1997.
WORLD HEALTH ORGANIZATION (WHO). Guidelines for Diagnosis, Treatment, Prevention and Control. New Edition. Geneva: World Health Organization; 2009.
YOUSAF, M. Z.; SIDDIQUE, A.; ASHFAQ, U. A.; ALI, M. Scenario of dengue infection & its control in Pakistan: an update and way forward. Asian Pacific Journal of Tropical Medicine, v. 11, n. 1, p. 15, 2018.
ZEA, D.; FOLEY, K.; CAREY, J. Case Report: Myocarditis in a traveler returning from the Dominican Republic: An unusual presentation of dengue fever. American Journal of Tropical Medicine and Hygiene, v. 91, n. 1, p. 156, 2014.
