Dengue-Associated Myocarditis: Clinical Spectrum, Pathogenesis, and Implications for Shock and Mortality

Dengue-Associated Myocarditis

Abstract

Dengue fever is one of the most common mosquito-borne viral infections of the tropical or subtropical areas with frequent outbreaks resulting in high mortality rates globally. Substantial evidences suggest key role of myocarditis in driving dengue shock syndrome leading to hospitalization and death. Dengue-related myocarditis presents a great challenge in its diagnosis either due to a high proportion of subclinical cases or due to the clinical manifestations such as tachycardia, hypotension, and fluid movements, which are often misleading and suggest dengue onset. Even though cardiogenic shock is not as frequent as hypovolemic shock caused by plasma leakage, it is a fatal complication that must be addressed with standard management measures. Dengue myocarditis is one of the blind spots in clinical research, despite the increasing evidence particularly in resource-limited countries where dengue cases are alarming. The outcomes could be further improved by increasing awareness of the clinicians and the routine cardiac examination of moderate to severe dengue patients. Dengue myocarditis is a significant yet an overlooked heinous cause of shock and death; its real burden is likely to be under-reported due to the challenges of its diagnosis and similarity to the traditional dengue pathophysiology. Better clinical vigilance, rigorous examination of the heart in patients at high risk and more research about the customized management is urgently required. These practices can be used to address current gaps in care and coping with this uncharacteristic health complication (Ref: Full Text Article).