Author ORCID Identifier
https://orcid.org/0000-0001-7942-2713
Abstract
Background- Dengue is one of the most important mosquito-borne illnesses worldwide. Cardiac manifestations of dengue illness can range from asymptomatic bradycardia to life-threatening myocarditis. There is an overall paucity of published Indian studies of clear demonstration of cardiac manifestations secondary to dengue in the pediatric population. Aim- To study the proportion of patients with cardiac involvement secondary to dengue viral infection in the pediatric age group based on clinical manifestations of cardiac enzymes (CKMB, Troponin I) and ECG (electrocardiography), in a tertiary center. Methodology- This study is undertaken to find out the proportion of patients with cardiac manifestations secondary to dengue in the pediatric population aged between 1 to 18 years admitted in a tertiary center. A total of 51 patients who had positive tests for dengue (NS1 or IgM antibody) with or without IgG positive were included in the study. Cardiac enzymes i.e. CK MB and Troponin I were done for all dengue patients at the time of admission. Also, repeat CK-MB and Troponin I were done on day 3 and at any time if the patient has new emerging cardiac symptoms like chest pain, oedema, hypotension and arrhythmia. If any abnormalities are detected on ECG and/or of levels of cardiac enzymes, 2D cardiac echography was done to assess cardiac function. Results-Sinus bradycardia was the predominant manifestation of ECG in dengue viral fever patients. 13.7% (n=7) had abnormal ECG on day 3 of admission. Out of these 7 patients, 85.71% were in the recovery phase and 1.96% were in the critical phase of dengue at that time. There was a significant association between CK-MB and clinical cardiac manifestations at the time of admission. It was observed that there was no correlation between cardiac biomarkers and ECG or 2D echocardiography findings. Conclusion- Patients manifest with a variety of clinical features suggesting cardiac involvement many of which overlap with other complications of the condition. Cardiac involvement in dengue fever is often underdiagnosed owing to a low index of clinical suspicion, its overlapping clinical manifestations and low sensitivity and specificity of clinical features of myocarditis.
Publication Date
Summer 4-2025
Conflict of Interest
nil
Keywords
Dengue fever, myocarditis, Cardiac enzymes
Word Count
3500
Recommended Citation
Bhongale N, Ansari Q, Chittal R.
Study of Proportion of Cardiac Involvement Secondary to Dengue Infection in Pediatric Population Admitted in a Tertiary Hospital- A Prospective Cross-Sectional Study.
Digital Journal of Clinical Medicine.
2025;
7(1):
-.
doi:
https://doi.org/10.55691/2582-3868.1230
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Included in
Diseases Commons, Health Information Technology Commons, Medical Education Commons, Medical Pathology Commons, Medical Specialties Commons, Public Health Education and Promotion Commons
Comments
Dear Reviewer,
Thank you for your valuable feedback on our manuscript titled “Study of Proportion of Cardiac Involvement Secondary to Dengue Infection in Pediatric Population Admitted in a Tertiary Hospital – A Prospective Cross-Sectional Study.” We appreciate your time and effort in reviewing our work and have carefully addressed all your comments.
1. Sample Size is Less, and the Number of Patients with Cardiac Manifestations is Very Small to Draw a Conclusion.
Response: We acknowledge that the sample size is relatively small. However, pediatric studies on cardiac involvement in dengue are limited, and our study contributes to the existing literature. Our findings highlight the potential underdiagnosis of cardiac manifestations in pediatric dengue, emphasizing the need for further large-scale, multicentric studies to better understand this association. We have added this limitation explicitly in the revised manuscript.
2. How Many (%) Patients Were NS1 Positive?
Response: In our study, 90.2% (46 out of 51) patients were NS1 positive. This detail has been explicitly mentioned in the Results section for clarity.
3. What Were the Cardiac Symptoms and Signs Observed in the 4 Patients with Raised CK-MB Levels on Admission?
Response: Out of the 4 patients with raised CK-MB levels on admission, 3 exhibited cardiac symptoms or signs, which included:
• Hypotension (1 patient)
• Persistent vomiting (2 patients)
• Chest pain (1 patient)
• Restlessness/lethargy (1 patient)
This information has been clearly mentioned in the Results section in the revised manuscript.
4. Apart from Sinus Bradycardia and Tachycardia, What Were the Other Abnormal ECG Findings?
Response: The predominant ECG abnormality observed was sinus bradycardia (13.7%), followed by sinus tachycardia (1.96%). Additionally, one patient exhibited ventricular ectopic beats on day 3 of admission. No other significant ECG abnormalities, such as ST-T changes or conduction blocks, were noted. This has been added to the discussion section.
5. Conclusion Should Be Limited to Study Findings.
Response: We have revised the Conclusion section to strictly reflect the findings of our study without generalizing beyond the observed data. The revised conclusion now states:
“Sinus bradycardia was the most common ECG abnormality observed in dengue patients. There was a significant association between CK-MB elevation and clinical cardiac manifestations at the time of admission. However, no correlation was observed between cardiac biomarkers (CK-MB, Troponin I), ECG findings, and 2D echocardiography. Our findings suggest that routine cardiac evaluation in pediatric dengue cases may help identify subclinical cardiac involvement, but further large-scale studies are required to establish a definitive correlation.”
6. If AI Was Used for Manuscript Writing, Please Acknowledge It.
Response: This manuscript was written and edited by the authors.
We appreciate the reviewer’s insightful comments, which have helped improve the clarity and rigor of our study. Please find the revised manuscript attached for your kind review.
With regards,
Dr.Qudsiya Ansari