Comparison of cardiac marker profiles in dengue myocarditis

https://doi.org/10.19106/JMedSci005501202304

Galang Tri Atmaja(1), Sarah Buntubatu(2), Conroy Surya Wijaya(3), Annisa Nurul Pratiwi Sudarmadi(4), Ida Safitri Laksono(5), Ratni Indrawanti(6), Eggi Arguni(7*)

(1) Undergraduate Program of Medical Doctor, Faculty of Medicine, Public Health and Nursing/Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada /RSUP Dr. Sardjito, Yogyakarta
(2) Karubaga District Hospital, Papua Pegunungan Province
(3) Undergraduate Program of Medical Doctor, Faculty of Medicine, Public Health and Nursing
(4) Undergraduate Program of Medical Doctor, Faculty of Medicine, Public Health and Nursing
(5) Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada /RSUP Dr. Sardjito, Yogyakarta
(6) Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada /RSUP Dr. Sardjito, Yogyakarta
(7) Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada /RSUP Dr. Sardjito, Yogyakarta
(*) Corresponding Author

Abstract


Dengue patients may experience some grade of severity. Cardiac involvement is common in severe dengue, therefore cardiac markers could be used to ensure the diagnosis of dengue myocarditis. However, information of the cardiac marker profiles in patients with milder severity of dengue infection is limited. The study aimed to evaluate creatinine kinase (CK), creatinine kinase-MB (CK-MB) and troponin I (TnI) in dengue myocarditis against the spectrum severity of dengue infection in children. This cross-sectional study was conducted using secondary data from medical records of dengue myocarditis patients aged 1-18 yr in Dr. Sardjito General Hospital, Yogyakarta. Fisher’s Exact tests were performed to compare the increase in cardiac markers to the dengue severity. The increase of CK was observed in dengue fever/DF (6 or 75% of patients), dengue hemorrhagic fever/DHF (6 or 67%) and dengue shock syndrome/DSS (16 or 73%). Furthermore, the increase of CK-MB was also observed in DF (6 or 75%), DHF (8 or 87%), and DSS (21 or 95%). No significant difference in the increase of CK and CK-MB proportions was observed in DF compared to DHF groups and in DF compared to DSS (p>0.05). The increase of Tn I was observed in DHF (2 or 22%) and DSS (10 or 45%) groups but not observed in DF group. Significant difference in the increase of Tn I proportion was observed in DF compared to DSS groups (p=0.022). In conclusion, cardiac involvement is common in all dengue severity level. The increment of Tn I corresponds to an increase in the dengue severity level. Further research by observing cardiac markers sequentially is needed.


Keywords


cardiac marker; dengue; myocarditis

Full Text:

PDF


References


1.World Health Organization. Dengue and severe dengue. Published 2022. Accessed May 15, 2022. http://www.who.int/mediacentre/factsheets/fs117/en/
2.Kementerian Kesehatan Republik Indonesia. Profil kesehatan Indonesia tahun 2021. Jakarta: Kementerian Kesehatan Republik Indonesia, 2022.
3.Kementerian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran tata laksana infeksi dengue anak dan remaja. Jakarta: Kemesterian Kesehatan Republik Indonesia, 2021.
4.WHO. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Geneva: WHO, 2011.
5.Kadam DB, Salvi S, Chandanwale A. Expanded dengue. J Assoc Physicians India 2016; 64(7):59-63.
6.Miranda CH, Borges MC, Matsuno AK, Vilar FC, Gali LG, Volpe GJ, et al. Evaluation of cardiac involvement during dengue viral infection. Clin Infect Dis 2013; 57(6):812-9.
https://doi.org/10.1093/cid/cit403
7.Kularatne SAM, Pathirage MMK, Kumarasiri PVR, Gunasena S, Mahindawanse SI. Cardiac complications of a dengue fever outbreak in Sri Lanka, 2005. Trans R Soc Trop Med Hyg 2007; 101(8):804-8.
https://doi.org/10.1016/j.trstmh.2007.02.021
8.Buntubatu S, Prawirohartono EP, Arguni E. Myocarditis prevalence in paediatric dengue infection: a prospective study in tertiary hospital in Yogyakarta, Indonesia. J Trop Pediatr 2019; 65(6):603-8.
https://doi.org/10.1093/tropej/fmz020
9.Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation 2006; 113(6):876-90.
https://doi.org/10.1161/CIRCULATIONAHA.105.584532
10.Yacoub S, Wertheim H, Simmons CP, Screaton G, Wills B. Cardiovascular manifestations of the emerging dengue pandemic. Nat Rev Cardiol 2014; 11(6):335-45.
https://doi.org/10.1038/nrcardio.2014.40
11.Kirawittaya T, Yoon IK, Wichit S, Green S, Ennis FA, Gibbons RV, et al. Evaluation of cardiac involvement in children with dengue by serial echocardiographic studies. PLoS Negl Trop Dis 2015; 9(7):e0003943.
https://doi.org/10.1371/journal.pntd.0003943
12.Hussain SBS, Kuswiyanto RB, Iwan J. Electrocardiogram profile in children with dengue infection at Dr. Hasan Sadikin General Hospital and Bandung City Hospital. Althea Med J 2016; 3(4):629-32.
https://doi.org/10.15850/amj.v3n4.950
13.Li Y, Hu Z, Huang Y, Huang Z, Li J, Hong W, et al. Characterization of the myocarditis during the worst outbreak of dengue infection in China. Medicine (Baltimore) 2016; 95(27):e4051.
https://doi.org/10.1097/MD.0000000000004051
14.Bodor GS. Biochemical markers of myocardial damage. EJIFCC 2016; 27(2):95-111.
15.Iskandar B, Juherinah, Daud D, Febriani ADB. The levels of troponin T in patients with dengue hemorrhagic fever. Am J Clin Exp Med 2015; 3(4):149-53.
https://doi.org/10.11648/j.ajcem.20150304.14
16.Yacoub S, Griffiths A, Hong Chau TT, Simmon CP, Wills B, Hien TT, et al. Cardiac function in Vietnamese patients with different dengue severity grades. Crit Care Med 2012; 40(2):477-83.
https://doi.org/10.1097/CCM.0b013e318232d966
17.Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart 2006; 92(7):987-93.
https://doi.org/10.1136/hrt.2005.071282
18.Aydin S, Ugur K, Aydin S, Sahin I, Yardim M. Biomarkers in acute myocardial infarction: current perspectives. Vasc Health Risk Manag 2019; 15:1-10.
https://doi.org/10.2147/VHRM.S166157
19.Shivanthan MC, Navinan MR, Constantine GR, Rajapakse S. Cardiac involvement in dengue infection. J Infect Dev Ctries 2015; 9(04):338-46.
https://doi.org/10.3855/jidc.6200



DOI: https://doi.org/10.19106/JMedSci005501202304

Article Metrics

Abstract views : 782 | views : 854




Copyright (c) 2023 Galang Tri Atmaja, Conroy Surya Wijaya, Annisa Nurul Pratiwi Sudarmadi, Ida Safitri Laksono, Ratni Indrawanti, Eggi Arguni

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

View My Stats

 

Creative Commons License
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Based on a work at http://jurnal.ugm.ac.id/bik/.