Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 276 AFRICA Review Article Dengue and the heart Diego Araiza-Garaygordobil, Carlos Eduardo García-Martínez, Lucrecia María Burgos, Clara Saldarriaga, Kiera Liblik, Ivan Mendoza, Manuel Martinez-Selles, Cristhian Emmanuel Scatularo, Juan Maria Farina, Adrian Baranchuk, on behalf of the Neglected Tropical Diseases and other Infectious Diseases affecting the Heart (the NET-Heart) project Abstract Dengue is a neglected viral arthropod-borne tropical disease transmitted by the bite of infected Aedes spp . mosquitoes. It is responsible for a significant global burden of disease and corresponding socio-economic implications. There are four different virus serotypes, all of which are found predominantly in countries with tropical climates. Patients with dengue may present with cardiovascular (CV) manifestations, contribut- ing to associated death and disability. A systematic review was conducted to identify CV manifestations of dengue, wherein 30 relevant studies were identified in the MEDLINE and PubMed databases. CV complications of dengue include rhythm abnormalities, hypotension, myocarditis, pericarditis and deterioration in myocardial function. Prompt recognition and treatment of CV complications of dengue are essential to reduce morbidity and mortality in these patients, who are at risk of progressing to cardiogenic shock and heart failure. Keywords: dengue, cardiovascular involvement, myocarditis, neglected tropical diseases Submitted 15/4/21, accepted 24/6/21 Published online 20/7/21 Cardiovasc J Afr 2021; 32 : 276–283 www.cvja.co.za DOI: 10.5830/CVJA-2021-033 Dengue: A neglected tropical disease Dengue is a neglected tropical disease (NTD), which is predominantly spread through bites of Aedes ssp . mosquitoes that have previously bitten an infected person. The four serotypes of dengue (DENV 1 to 4) are considered a major public health problem due to their geographical breadth, large number of cases, and disease severity in severe dengue forms. 1 The disease is endemic to tropical regions of over 100 countries in Africa, Central and South America, the Middle East, south- east Asia and the Pacific Islands (Fig. 1). 2 Dengue transmission is influenced by weather, rain, temperature, urbanisation and distribution of the principal mosquito vector Aedes aegypti. 2 The majority (80%) of dengue cases are asymptomatic or present with mild symptoms. 1 A small proportion of patients may experience severe dengue (approximately 5%), which is characterised by the presence of either severe plasma leakage (with shockor fluid accumulationwith respiratory distress), severe bleeding or severe organ impairment. These include hepatitis, neurological dysfunction, coagulopathy and cardiovascular (CV) complications. 2 CV manifestations have been reported in up to 12.5% of patients with severe dengue. 3 However, research regarding the clinical presentation, pathophysiology, diagnosis and prognostic significance is scarce. The majority of literature about CV involvement comes from case reports and small studies. Coronary Care Unit, National Institute of Cardiology of Mexico, Mexico Diego Araiza-Garaygordobil, MD, MSc, FACC Cardiac Catheterization Laboratory, Centro Cardiológico Americano, Montevideo, Uruguay Carlos Eduardo García-Martínez, MD, MSc Department of Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina Lucrecia María Burgos, MD Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellín, Colombia Clara Saldarriaga, MD, FACC, FESC, FSIAC Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Ontario, Canada Kiera Liblik, BSc Tropical Cardiology, Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela Ivan Mendoza, MD, MSc, FACC, FSIAC Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain Manuel Martinez-Selles, MD, PhD Division of Cardiology, Sanatorio de la Trinidad Palermo, Buenos Aires City, Argentina Cristhian Emmanuel Scatularo, MD Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina Juan Maria Farina, MD Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Ontario, Canada Adrian Baranchuk, MD, FACC, FRCPC, FCCS, FSIAC, Adrian. Baranchuk@kingstonhsc.ca