Open Access Highly Accessed Research article

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

Kosala GAD Weerakoon1, Senanayake AM Kularatne1*, Deepthika H Edussuriya2, Sarachchandra KA Kodikara2, Laxman PG Gunatilake2, Vasanti G Pinto3, Ashoka B Seneviratne4 and Sunethra Gunasena5

Author Affiliations

1 Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka

2 Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka

3 Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, Sri Lanka

4 General Hospital, Kandy, Sri Lanka

5 Department of Virology, Medical Research Institute, Colombo 8, Sri Lanka

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BMC Research Notes 2011, 4:268  doi:10.1186/1756-0500-4-268

Published: 29 July 2011

Abstract

Background

In 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.

Methods

The 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.

Results

Of 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.

Conclusions

The histology supports occurrence of myocarditis in dengue infection.