July 1, 2016Medicine55 citationsOpen Access

Characterization of the Myocarditis during the worst outbreak of dengue infection in China

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Dengue infection (n=1782). Intervention: Severe dengue or dengue with warning signs [NSD(WS+)/SD] vs. Nonsevere dengue without warning signs [NSD(WS-)]. Primary outcome: Prevalence of myocarditis.

YLYingying LiCapital Medical University ZHZhong-wei HuCivil Aviation University of China YHYuli HuangTaipei Medical University Hospital

Key Result

The prevalence of myocarditis in hospitalized dengue patients was 11.28%, with a notably higher prevalence in patients with severe dengue or warning signs compared to those without warning signs (46.66% vs. 9.72%).

Study Design

Type

Observational (n=1,782)

Multicenter

PICO

Population

1,782 hospitalized patients with dengue infection evaluated for the prevalence and clinical characteristics of myocarditis during the 2014 outbreak in China.

Exposure / Comparator

Severe dengue or dengue with warning signs [NSD(WS+)/SD] vs Nonsevere dengue without warning signs [NSD(WS-)]

Primary Outcome

Prevalence of myocarditis

Main Result

Absolute Event Rate: 46.66% vs 9.72%

Limitations

Age composition is not balanced (older people are more in all groups)
Missing social risk factors data
Impossible to completely exclude coinfections, such as enteroviruses
Some patients with past history of cardiac disease may have been included
Did not classify the serotypes distribution in dengue myocarditis
Too few outpatients with mild symptoms included in the study

Abstract

Myocarditis is a common complication of severe dengue infection. However, data about prevalence and characterization of myocarditis in dengue are still lacking. In 2014, the worst outbreak of dengue in the last two decades in China occurred. In this study, we described the clinical and laboratory diagnostic features of dengue with myocarditis. Totally, 1782 diagnosed dengue patients were admitted from August to October, 2014, all of whom were subjected to electrocardiogram, ultrasound cardiogram, and cardiac enzyme test. About 201 cases of dengue patients were diagnosed with myocarditis and the prevalence of myocarditis in hospitalized dengue was 11.28%. The prevalence of myocarditis in nonsevere dengue with warning signs and severe dengue NSD(WS+)/SD and nonsevere dengue without warning signs NSD(WS-) was 46.66% and 9.72%, respectively. The NSD(WS+)/SD patients with myocarditis presented with higher incidence of cardiac symptoms, supraventricular tachycardia (14.29% vs. 0%, P < 0.001), atrial fibrillation (25.71% vs. 10.24%, P = 0.019) and heart failure compared with NSD (WS-) patients with myocarditis. About 150 cases of dengue patients without myocarditis in the same period of time in department of Cardiology were recruited as control group. The proportion of NSD(WS+)/SD in dengue patients with and without myocarditis was 17.41% and 2.53%, respectively. Dengue patients with myocarditis experienced longer hospital stay than those without myocarditis (7.17 ± 4.64 vs. 5.98 ± 2.69, P = 0.008). There was no difference between patients with and without myocarditis in the proportion of symptoms, auxiliary methods abnormality, arrhythmia, and heart failure on the discharge day. Our study demonstrates the prevalence of myocarditis in worst outbreak of dengue in China was 11.28% and the incidence of myocarditis increased with the severity of dengue. The NSD(WS+)/SD patients with myocarditis presented with higher incidence of cardiac complication compared with NSD (WS-) patients with myocarditis. The prognosis of dengue patients with and without myocarditis had no significant difference even if myocarditis patients experienced longer hospital stay.

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