Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka
OBJECTIVE: Dengue is a mosquito-borne Arbor-viral infection with four main subtypes. Sri Lanka has been affected by several dengue epidemics during the last three decades. The clinicopathological entities of dengue may differ with each individual subtype or combination. This study describes clinicop...
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| Format: | Article |
| Language: | English |
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Verduci Editore
2021-10-01
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| Series: | Infectious Diseases and Tropical Medicine |
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| Online Access: | https://www.infectiousjournal.com/wp-content/uploads/sites/6/2021/10/e771.pdf |
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| author | H. Dandeniya-Arachchi R. Ruwanpura S. Hulathduwa |
| author_facet | H. Dandeniya-Arachchi R. Ruwanpura S. Hulathduwa |
| author_sort | H. Dandeniya-Arachchi |
| collection | DOAJ |
| description | OBJECTIVE: Dengue is a mosquito-borne Arbor-viral infection with four main subtypes. Sri Lanka has been affected by several dengue epidemics during the last three decades. The clinicopathological entities of dengue may differ with each individual subtype or combination. This study describes clinicopathological findings of a series of 7 fatal dengue cases during an outbreak in early 2019, mainly due to Dengue virus three serotype (DENV3).
CASE PRESENTATION: All seven cases were serologically diagnosed and managed as Dengue infection at Teaching Hospital, Karapitiya during the year 2019. Out of these, four were female, and three were male, with a majority between 30 to 35 years. Six patients had been managed with blood transfusion, and two of them had undergone dialysis. All deaths in this study have occurred between 6 to 8 days of the first symptom, during the leaking phase. Autopsies revealed evidence of plasma leakage and bleeding with DIC in all cases. Hepato-renal involvement was confirmed microscopically with evidence of acute liver cell necrosis and acute tubular necrosis. Diffuse alveolar damage suggestive of ARDS was seen in five, while viral myocarditis was diagnosed in two cases. Cerebral involvement was not prominent except severe cerebral oedema seen in one case suggestive of viral encephalopathy that presented with fits.
CONCLUSIONS: In this cohort, the majority has presented with typical symptoms and deteriorated rapidly since day 4 or 5 onwards until death intervened with multi-organ failure and shock. Knowledge regarding sequential epidemics caused by different serotypes of dengue virus together with their clinicopathological entities is essential for early prediction and proper interventions. |
| first_indexed | 2024-04-10T23:56:19Z |
| format | Article |
| id | doaj.art-0b6657a989624c8db85ee40cb3e96ff9 |
| institution | Directory Open Access Journal |
| issn | 2379-4054 |
| language | English |
| last_indexed | 2024-04-10T23:56:19Z |
| publishDate | 2021-10-01 |
| publisher | Verduci Editore |
| record_format | Article |
| series | Infectious Diseases and Tropical Medicine |
| spelling | doaj.art-0b6657a989624c8db85ee40cb3e96ff92023-01-10T10:49:56ZengVerduci EditoreInfectious Diseases and Tropical Medicine2379-40542021-10-01710.32113/idtm_202110_771771Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri LankaH. Dandeniya-Arachchi0R. Ruwanpura1S. Hulathduwa2Forensic Medicine Unit, Teaching Hospital Karapitiya, Galle, Sri LankaForensic Medicine Unit, Teaching Hospital Karapitiya, Galle, Sri LankaForensic Medicine, University of Sri Jayawardenepura, Nugegoda, Sri LankaOBJECTIVE: Dengue is a mosquito-borne Arbor-viral infection with four main subtypes. Sri Lanka has been affected by several dengue epidemics during the last three decades. The clinicopathological entities of dengue may differ with each individual subtype or combination. This study describes clinicopathological findings of a series of 7 fatal dengue cases during an outbreak in early 2019, mainly due to Dengue virus three serotype (DENV3). CASE PRESENTATION: All seven cases were serologically diagnosed and managed as Dengue infection at Teaching Hospital, Karapitiya during the year 2019. Out of these, four were female, and three were male, with a majority between 30 to 35 years. Six patients had been managed with blood transfusion, and two of them had undergone dialysis. All deaths in this study have occurred between 6 to 8 days of the first symptom, during the leaking phase. Autopsies revealed evidence of plasma leakage and bleeding with DIC in all cases. Hepato-renal involvement was confirmed microscopically with evidence of acute liver cell necrosis and acute tubular necrosis. Diffuse alveolar damage suggestive of ARDS was seen in five, while viral myocarditis was diagnosed in two cases. Cerebral involvement was not prominent except severe cerebral oedema seen in one case suggestive of viral encephalopathy that presented with fits. CONCLUSIONS: In this cohort, the majority has presented with typical symptoms and deteriorated rapidly since day 4 or 5 onwards until death intervened with multi-organ failure and shock. Knowledge regarding sequential epidemics caused by different serotypes of dengue virus together with their clinicopathological entities is essential for early prediction and proper interventions.https://www.infectiousjournal.com/wp-content/uploads/sites/6/2021/10/e771.pdfclinico-pathological findingsdengue hemorrhagic fevermulti-organ failuredisseminated intravascular coagulationviral pericarditis |
| spellingShingle | H. Dandeniya-Arachchi R. Ruwanpura S. Hulathduwa Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka Infectious Diseases and Tropical Medicine clinico-pathological findings dengue hemorrhagic fever multi-organ failure disseminated intravascular coagulation viral pericarditis |
| title | Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka |
| title_full | Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka |
| title_fullStr | Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka |
| title_full_unstemmed | Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka |
| title_short | Pathophysiology of Dengue haemorrhagic fever: an autopsy cases series during an outbreak in 2019, Galle, Sri Lanka |
| title_sort | pathophysiology of dengue haemorrhagic fever an autopsy cases series during an outbreak in 2019 galle sri lanka |
| topic | clinico-pathological findings dengue hemorrhagic fever multi-organ failure disseminated intravascular coagulation viral pericarditis |
| url | https://www.infectiousjournal.com/wp-content/uploads/sites/6/2021/10/e771.pdf |
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