Cargando…

2654. Myocarditis in Dengue: A Prospective Observational Study

BACKGROUND: Cardiac involvement in dengue fever is underdiagnosed due to low index of suspicion and overlapping clinical manifestations of capillary leak associated with dengue. The frequency of subclinical dengue myocarditis and its relative contribution to the hemodynamic instability in severe den...

Descripción completa

Detalles Bibliográficos
Autores principales: Soneja, Manish, Bhatt, Manasvini, Farooqui, Faraz A, Vikram, Naval K, Biswas, Ashutosh, Roy, Ambuj, Wig, Naveet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810041/
http://dx.doi.org/10.1093/ofid/ofz360.2332
_version_ 1783462149837815808
author Soneja, Manish
Bhatt, Manasvini
Farooqui, Faraz A
Vikram, Naval K
Biswas, Ashutosh
Roy, Ambuj
Wig, Naveet
author_facet Soneja, Manish
Bhatt, Manasvini
Farooqui, Faraz A
Vikram, Naval K
Biswas, Ashutosh
Roy, Ambuj
Wig, Naveet
author_sort Soneja, Manish
collection PubMed
description BACKGROUND: Cardiac involvement in dengue fever is underdiagnosed due to low index of suspicion and overlapping clinical manifestations of capillary leak associated with dengue. The frequency of subclinical dengue myocarditis and its relative contribution to the hemodynamic instability in severe dengue needs to be explored. We studied the prevalence of myocarditis and clinical outcomes among admitted patients with dengue. METHODS: A prospective observational study was carried out in admitted patients with age between 18 and 65 years having confirmed dengue (NS1/IgM ELISA). Patients with electrolyte abnormalities or on medications affecting heat rhythm/ rate, pre-existing heart disease were excluded. The baseline demographic, clinical and laboratory parameters were collected. A baseline ECG was done and repeated every second day. Trop-I and NT-proBNP were done at baseline and repeated only if elevated at baseline or there were ECG changes. The cardiac enzymes were measured using enzyme-linked fluorescent assay (VIDAS, bioMérieux, France). Patients with elevated enzymes underwent 2-dimensional echocardiography. Diagnosis of myocarditis was as per ESC 2013 criteria. Fluid management was as per WHO guidelines (2009). RESULTS: A total of 183 patients were recruited with median age of 29 years (IQR 21, 37) and 31% were females. Dengue with warning signs was present in 80 (44%) and severe dengue in 45 (25%) patients. Cardiac enzymes were elevated in 27 (15%) patients (cTnI in 25, NT-proBNP in 22). Among these 27 patients, 11 [6% (2.6–9.4, 95% CI)] had echo evidence and diagnosed as having myocarditis according to ESC 2013 criteria (Figure 1). Clinical features of fluid overload were more common in myocarditis group [8 (73%) vs 4 (2%), P = Overall, 5 (2.7%) patients expired, all of them had myocarditis (5/11 = 45%). These patients had severe dengue, 2 patients developed hospital-acquired pneumonia and 1 had malaria co-infection. Among patients with raised enzymes and normal echo (n = 16), 3 patients developed clinical signs of fluid overload compared with only 1 out of 156 patients without raised enzymes (P < 0.01). CONCLUSION: Myocarditis in admitted patients with dengue is not uncommon [6% (2.6–9.4, 95% CI)] and may lead to a complicated disease course. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-6810041
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-68100412019-10-28 2654. Myocarditis in Dengue: A Prospective Observational Study Soneja, Manish Bhatt, Manasvini Farooqui, Faraz A Vikram, Naval K Biswas, Ashutosh Roy, Ambuj Wig, Naveet Open Forum Infect Dis Abstracts BACKGROUND: Cardiac involvement in dengue fever is underdiagnosed due to low index of suspicion and overlapping clinical manifestations of capillary leak associated with dengue. The frequency of subclinical dengue myocarditis and its relative contribution to the hemodynamic instability in severe dengue needs to be explored. We studied the prevalence of myocarditis and clinical outcomes among admitted patients with dengue. METHODS: A prospective observational study was carried out in admitted patients with age between 18 and 65 years having confirmed dengue (NS1/IgM ELISA). Patients with electrolyte abnormalities or on medications affecting heat rhythm/ rate, pre-existing heart disease were excluded. The baseline demographic, clinical and laboratory parameters were collected. A baseline ECG was done and repeated every second day. Trop-I and NT-proBNP were done at baseline and repeated only if elevated at baseline or there were ECG changes. The cardiac enzymes were measured using enzyme-linked fluorescent assay (VIDAS, bioMérieux, France). Patients with elevated enzymes underwent 2-dimensional echocardiography. Diagnosis of myocarditis was as per ESC 2013 criteria. Fluid management was as per WHO guidelines (2009). RESULTS: A total of 183 patients were recruited with median age of 29 years (IQR 21, 37) and 31% were females. Dengue with warning signs was present in 80 (44%) and severe dengue in 45 (25%) patients. Cardiac enzymes were elevated in 27 (15%) patients (cTnI in 25, NT-proBNP in 22). Among these 27 patients, 11 [6% (2.6–9.4, 95% CI)] had echo evidence and diagnosed as having myocarditis according to ESC 2013 criteria (Figure 1). Clinical features of fluid overload were more common in myocarditis group [8 (73%) vs 4 (2%), P = Overall, 5 (2.7%) patients expired, all of them had myocarditis (5/11 = 45%). These patients had severe dengue, 2 patients developed hospital-acquired pneumonia and 1 had malaria co-infection. Among patients with raised enzymes and normal echo (n = 16), 3 patients developed clinical signs of fluid overload compared with only 1 out of 156 patients without raised enzymes (P < 0.01). CONCLUSION: Myocarditis in admitted patients with dengue is not uncommon [6% (2.6–9.4, 95% CI)] and may lead to a complicated disease course. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810041/ http://dx.doi.org/10.1093/ofid/ofz360.2332 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Soneja, Manish
Bhatt, Manasvini
Farooqui, Faraz A
Vikram, Naval K
Biswas, Ashutosh
Roy, Ambuj
Wig, Naveet
2654. Myocarditis in Dengue: A Prospective Observational Study
title 2654. Myocarditis in Dengue: A Prospective Observational Study
title_full 2654. Myocarditis in Dengue: A Prospective Observational Study
title_fullStr 2654. Myocarditis in Dengue: A Prospective Observational Study
title_full_unstemmed 2654. Myocarditis in Dengue: A Prospective Observational Study
title_short 2654. Myocarditis in Dengue: A Prospective Observational Study
title_sort 2654. myocarditis in dengue: a prospective observational study
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810041/
http://dx.doi.org/10.1093/ofid/ofz360.2332
work_keys_str_mv AT sonejamanish 2654myocarditisindengueaprospectiveobservationalstudy
AT bhattmanasvini 2654myocarditisindengueaprospectiveobservationalstudy
AT farooquifaraza 2654myocarditisindengueaprospectiveobservationalstudy
AT vikramnavalk 2654myocarditisindengueaprospectiveobservationalstudy
AT biswasashutosh 2654myocarditisindengueaprospectiveobservationalstudy
AT royambuj 2654myocarditisindengueaprospectiveobservationalstudy
AT wignaveet 2654myocarditisindengueaprospectiveobservationalstudy