Introduction: Dengue Haemorrhagic Fever (DHF) is a severe febrile disease caused by a Flavivirus.Four serotypes of dengue virus (DEN 1-4) are present and the large majority of DHF occurs following a secondary infection with a different serotype. About 0.5 million people in the world develop DHF annually with 24,000 deaths. Pathogenesis of the disease is still not fully understood. Target cells include dendritic reticulum cells, monocytes, lymphocytes, hepatocytes, and vascular endothelial cells.
Objectives: To describe the histopathological changes in the liver, lungs, heart, brain, spleen, gastrointestinal tract and kidneys in fatal DHF.
Materials and methods: Tissue from seventeen autopsies following DHF were processed routinely and stained with haematoxylin and eosin. Histopathological changes in the liver, lungs, heart, brain, spleen, gastrointestinal tract and kidneys were studied.
Results: Fifteen of 17 cases showed a liver pathology which included submassive necrosis (1/15), bridging necrosis (2/15), midzonal (3/15) and centrilobular necrosis (4/15), focal necrosis (2/15), apoptosis (1/15) and macrovesicular steatosis (7/15). Pulmonary haemorrhage was present in 13 cases and pulmonary oedema in 6 cases. Glomerular congestion and haemorrhage were seen in 6 and medullary congestion with haemorrhage was present in 9 cases. Gastrointestinal mucosal haemorrhages were seen in 8. One patient showed myocarditis and one showed myocardial haemorrhages. Cerebral oedema was present in 8 cases In 13 out of 17 cases the spleen showed red pulp congestion and haemorrhage.
Conclusion: DHF is a systemic viral infection causing multiorgan pathology. Liver, lungs and spleen are the most commonly affected organs.