title: Histopathological diagnosis of myocarditis in a dengue outbreak in Sri Lanka, 2009.
abstract: BACKGROUND
  In 2009, an outbreak of dengue caused high fatality in Sri Lanka. We conducted 5 autopsies of clinically suspected myocarditis cases at the General Hospital, Peradeniya to describe the histopathology of the heart and other organs.
  
  
  METHODS
  The diagnosis of dengue was confirmed with specific IgM and IgG ELISA, HAI and RT-PCR techniques. The histology was done in tissue sections stained with hematoxylin and eosin.
  
  
  RESULTS
  Of the 319 cases of dengue fever, 166(52%) had severe infection. Of them, 149 patients (90%) had secondary dengue infection and in 5 patients, DEN-1 was identified as the causative serotype. The clinical diagnosis of myocarditis was considered in 45(27%) patients. The autopsies were done in 5 patients who succumbed to shock (3 females and 2 males) aged 13- 31 years. All had pleural effusions, ascites, bleeding patches in tissue planes and histological evidence of myocarditis. The main histological findings of the heart were interstitial oedema with inflammatory cell infiltration and necrosis of myocardial fibers. One patient had pericarditis. The concurrent pulmonary abnormalities were septal congestion, pulmonary haemorrhage and diffuse alveolar damage; one case showed massive necrosis of liver.
  
  
  CONCLUSIONS
  The histology supports occurrence of myocarditis in dengue infection.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka. samkul@sltnet.lk.
authors.forename: Kosala Gad
authors.initials: KG
authors.lastname: Weerakoon
authors.forename: Senanayake Am
authors.initials: SA
authors.lastname: Kularatne
authors.forename: Deepthika H
authors.initials: DH
authors.lastname: Edussuriya
authors.forename: Sarachchandra Ka
authors.initials: SK
authors.lastname: Kodikara
authors.forename: Laxman Pg
authors.initials: LP
authors.lastname: Gunatilake
authors.forename: Vasanti G
authors.initials: VG
authors.lastname: Pinto
authors.forename: Ashoka B
authors.initials: AB
authors.lastname: Seneviratne
authors.forename: Sunethra
authors.initials: S
authors.lastname: Gunasena