Lung in dengue: computed tomography findings

Dengue is the most important mosquito-borne viral disease in the world. Dengue virus infection may be asymptomatic or lead to undifferentiated fever, dengue fever with or without warning signs, or severe dengue. Lower respiratory symptoms are unusual and lung-imaging data in patients with dengue are...

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Published in:	PloS one Vol. 9; no. 5; p. e96313
Main Authors:	Rodrigues, Rosana Souza, Brum, Ana Livia Garcia, Paes, Marciano Viana, Póvoa, Tiago Fajardo, Basilio-de-Oliveira, Carlos Alberto, Marchiori, Edson, Borghi, Danielle Provençano, Ramos, Grazielle Viana, Bozza, Fernando Augusto
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 16-05-2014 Public Library of Science (PLoS)
Subjects:	Abnormalities Adolescent Adult Aged Aged, 80 and over Airspace Alveoli Aquatic insects Blood CAT scans Chest Computation Computed tomography Consolidation Dengue Dengue - pathology Dengue fever Dengue hemorrhagic fever Diagnostic systems Disease Edema Education Epidemics Ethics Female Females Fever Health aspects Hemorrhage Humans Infection Infections Leptospirosis Lung - diagnostic imaging Lungs Male Males Medical diagnosis Medical imaging Medical personnel Medicine and Health Sciences Middle Aged Nodules Opacity Parenchyma Patients Physicians Pleural effusion Respiratory tract Retrospective Studies Septum Thickening Tomography Tomography, X-Ray Computed Tropical diseases Vector-borne diseases Viral diseases Viral infections Viruses Brazil Rio de Janeiro Brazil
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Summary:	Dengue is the most important mosquito-borne viral disease in the world. Dengue virus infection may be asymptomatic or lead to undifferentiated fever, dengue fever with or without warning signs, or severe dengue. Lower respiratory symptoms are unusual and lung-imaging data in patients with dengue are scarce. To evaluate lung changes associated with dengue infection, we retrospectively analyzed 2,020 confirmed cases of dengue. Twenty-nine of these patients (11 females and 18 males aged 16-90 years) underwent chest computed tomography (CT), which yielded abnormal findings in 17 patients: 16 patients had pleural effusion (the sole finding in six patients) and 11 patients had pulmonary abnormalities. Lung parenchyma involvement ranged from subtle to moderate unilateral and bilateral abnormalities. The most common finding was ground-glass opacity in eight patients, followed by consolidation in six patients. Less common findings were airspace nodules (two patients), interlobular septal thickening (two patients), and peribronchovascular interstitial thickening (one patient). Lung histopathological findings in four fatal cases showed thickening of the alveolar septa, hemorrhage, and interstitial edema. In this largest series involving the use of chest CT to evaluate lung involvement in patients with dengue, CT findings of lower respiratory tract involvement were uncommon. When abnormalities were present, pleural effusion was the most frequent finding and lung involvement was often mild or moderate and bilateral. Extensive lung abnormalities are infrequent even in severe disease and when present should lead physicians to consider other diagnostic possibilities.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conceived and designed the experiments: RSR ALGB MVP FAB. Analyzed the data: RSR ALGB MVP TFP CAB DPB FAB. Contributed reagents/materials/analysis tools: RSR ALGB MVP TFP CAB DPB GVR FAB. Wrote the paper: RSR MVP EM FAB. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0096313