Lung in dengue: computed tomography findings

• Published in: PloS one 2014-05, Vol.9 (5), p.e96313-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: Article
• Language: English
• 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
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0096313

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.