Electrocardiographic Changes in Dengue Fever: A Review of Literature

Rare occurrence of sagittal sinus thrombosis and haemorrhagic infarction with dengue fever: jumping from traditional symptoms to lethal neurological consequences

Introduction and importance

Dengue virus (DENV) is an RNA virus transmitted by Aides mosquito causing dengue fever. There is growing recognition of neurological symptoms associated with DENV infection, some of which might be lethal if left untreated. Case reports describing sagittal sinus thrombosis, as a serious neurologic consequence of dengue infection, are rare. It is still unknown how often sagittal sinus thrombosis occurs and what variables increase the risk in dengue patients.

Case presentation

Herein the authors presented an elderly Sudanese patient diagnosed with dengue fever. He was admitted, then 2 days after admission, the condition was complicated by atrial fibrillation, sagittal sinus thrombosis complicated by massive left temporal lobe infarction with haemorrhagic transformation and recurrent episodes of status epilepticus. After receiving the necessary care, his condition remained the same and no progress or deterioration was seen.

Clinical discussion

Sagittal sinus thrombosis can happen due to several underlying causes. DENV can very rarely lead to such condition. The authors' patient developed this condition, which was later complicated by ischaemic stroke with haemorrhagic transformation and status epilepticus. In addition to a familial history of DVT and a history of myocardial infarction, our patient also acquired cardiac mural thrombus and DVT throughout his illness, which increased the suspicion of a protein C, protein S, or antithrombin 3 deficiency.

Conclusion

Sagittal sinus thrombosis with haemorrhagic infarction associated with thrombocytopenia is a very rare kind of stroke that occurs in dengue. Dengue as a pathogenic mechanism of ischaemic stroke requires validation with further data.

Cardiac arrhythmias in viral infections

BACKGROUND

The current COVID-19 pandemic has led to many studies examining its arrhythmogenic effects. However, there are many other viruses that are capable of inducing arrhythmias that have not received as much attention. The objective of this study was to review common viruses and identify studies highlighting their arrhythmogenic effects.

METHODS AND RESULTS

In this review, we examined 15 viruses and the literature regarding their arrhythmogenic effects. The common mechanisms of action appear to be direct invasion of myocytes leading to immune mediated damage, infection of vascular endothelium, and alteration of cardiac ion channels.

CONCLUSIONS

This review highlights the growing evidence that supports the involvement of other viral infections in the development of arrhythmia. Physicians should be aware of these potentially life-threatening effects when caring for patients with these viruses, some of which are very common. Additional studies are required to better understand the complex mechanism and risk factors of cardiac arrhythmias in patients suffered from viral infections to determine whether the processes can be reversed or even prevented.

Multiplex Reverse Transcription Polymerase Chain Reaction Combined with a Microwell Hybridization Assay Screening for Arbovirus and Parasitic Infections in Febrile Patients Living in Endemic Regions of Colombia

Acute febrile syndrome is a frequent reason for medical consultations in tropical and subtropical countries where the cause could have an infectious origin. Malaria and dengue are the primary etiologies in Colombia. As such, constant epidemiological surveillance and new diagnostic tools are required to identify the causative agents. A descriptive cross-sectional study was conducted to evaluate the circulation and differential diagnosis of six pathogens in two regions of Colombia. The results obtained via multiplex reverse transcription polymerase chain reaction combined with a microwell hybridization assay (m-RT-PCR-ELISA) were comparable to those obtained using rapid tests conducted at the time of patient enrollment. Of 155 patients evaluated, 25 (16.1%) and 16 (10.3%) were positive for malaria and dengue, respectively; no samples were positive for any of the other infectious agents tested. In most cases, m-RT-PCR-ELISA confirmed the results previously obtained through rapid testing.

Neglected Tropical Diseases and Sudden Cardiac Death: The NET-Heart Project

Sudden cardiac death (SCD) is responsible for approximately 6% of global mortality and 25% of cardiovascular (CV) deaths. SCD has been traditionally linked to coronary artery disease, valvular heart disease, cardiomyopathies, and genetic arrhythmia disorders. However, advancements in care for these diseases have not translated to a proportional reduction in SCD. This suggests an important role of underrecognized contributing pathologies. Neglected tropical diseases (NTDs) are a group of illnesses prevalent in tropical and sub-tropical regions which have been understudied partially due to their high prevalence in marginalized populations. The relationship between SCD and Chagas disease has been well-established, though emerging literature suggests that other NTDs with CV involvement may lead to fatal arrhythmias. Additionally, specific therapies for a subset of NTDs put patients at increased risk of malignant arrhythmias and other cardiac complications. This review aims to summarize the association between a group of selected NTDs and SCD.

Atrial Fibrillation in Scrub Typhus: A Series of Four Cases

Scrub typhus, also known as bush typhus, is an acute febrile zoonosis caused by Orientia tsutsugamushi, transmitted by the bite of chigger mite. Patients with scrub typhus can have many different presentations such as acute hearing loss, interstitial pneumonitis, acute respiratory distress syndrome, myocarditis, pericarditis, meningoencephalitis, acute renal failure, acute hepatic failure, and septic shock. The occurrence of multi-organ dysfunction is responsible for high mortality seen in scrub typhus patients. Cardiovascular involvement can also occur in the form of arrhythmia, which leads to an increase in mortality in these patients, and if associated with ischemic heart disease and acute heart failure, it leads to higher mortality. The early use of antibiotics and telemetry monitoring along with aggressive management of patients can decrease the complications and mortality seen in these patients. This study describes a series of four scrub typhus patients with new-onset atrial fibrillation who were managed with either direct current (DC) cardioversion, amiodarone, or diltiazem.