Director - Liver Transplantation and HPB Surgeon
Published on 17/10/2022
One of the significant causes of fever in India is dengue, also known as "break-bone fever." Aedes aegypti mosquitoes typically spread the dengue disease. Most infected people experience asymptomatic symptoms or an undifferentiated viral fever-like illness due to dengue virus infection. However, in a small number of individuals, it may manifest as a severe condition, such as dengue hemorrhagic fever, that results in dengue shock syndrome.
The geographic expansion of this disease is fuelled by several causes, including unrelenting urbanization, poor sanitation, crumbling health systems, and rising international travel, which greatly raises the disease burden in tropical regions.
A well-known dengue consequence is the involvement of the liver, which results in liver dysfunction. Acute dengue infection is accompanied by varying degrees of liver involvement, which is likely to be caused by hepatocyte apoptosis caused directly by the virus, hypoxia brought on by decreased hepatic perfusion brought on by fluid leakage and oxidative stress, or immune-mediated harm.
The pathophysiology of dengue is multifactorial and includes direct viral injury, dysregulated immunological response, hypoxic/ischemic injury, and even secondary to medications like PCM that are frequently used to treat such symptoms and are not entirely understood.
Although adults have a little better prognosis than children, whose prognosis is 50%-66%, mortality figures are comparable with other forms of ALF.
Acute liver failure caused by dengue is associated with a significant mortality rate because of side effects such as encephalopathy, severe bleeding, renal failure, and metabolic acidosis. Additionally, dengue has been linked to the progression of chronic liver disease, acting as the acute component of acute and chronic liver failure.
Along with supporting interventions, specific measures have been successfully attempted in managing patients with dengue and ALF. N-acetyl cysteine (NAC) has been mentioned in several case studies. It has been documented that ALF connected to dengue use a molecular adsorbent recirculating system (MARS). Due to organ damage, hemorrhage, and hemodynamic compromise brought on by dengue infection, liver transplantation becomes a challenging prospect.