Nguyen Trong
Lan, Nguyen Thanh Hung, Vincent Deubel
Michel Huerre, Do Quang Ha, Vu Thi Que Huong
Dengue haemorrhagic fever (DHF) is an acute viral disease caused by Dengue viruses. The DHF patients often show a hypovolemic shock and haemorrhagic manifestations due to the thrombocytopenia. In some severe cases of Dengue shock syndrome (DSS), the neurological symptoms such as coma, convulsion etc. may contribute to the hepatic necrosis phenomenon.
The impact of DHF on liver function was studied by measuring serum transaminase levels in 45 patients with DHF confirmed by virus isolation and serodiagnosis in 1995. Abnormal levels of AST and ALT were observed in 97.7% and 37.3% of the patients, respectively. The fact that the level of AST was higher than that of ALT and the elevation of transaminases was mild to moderate in most cases (<5-fold greater than the normal upper limit for AST and ALT) showed that liver involvement was also mild to moderate in most cases of DHF. The transaminases did not differ significantly between cases with and without hepatitis B or hepatitis C infection, nor between primary and secondary dengue infection, but a significantly higher elevation of AST and ALT was observed in DHF patient with gastrointestinal haemorrhage.
Two patients with dengue encephalopathy in 1992 and one patient with dengue encephalopathy who died of massive gastrointestinal haemorrhage in 1995 had unusually high transaminase levels which were considered as a sign of acute liver failure. The autopsy of one DHF case in 1996 caused by Dengue-3 virus showed a severe necrosis with steatosis in his liver.
It is concluded that DHF may cause mild to moderate liver dysfunction in most cases; but only some patients may suffer from acute liver failure leading to encephalopathy and death. This suggests that the liver plays a very important role in the evolution of DHF fatal form in children.