Year : 2011 | Volume
: 14 | Issue : 3 | Page : 245-
Dengue fever in a patient recovering from coronary artery bypass grafting
Subhash C Arya1, Nirmala Agarwal2,
1 Department of Clinical Microbiology and Infection Control, Sant Parmanand Hospital, Delhi, India
2 Department of Gynecology and Obstetrics, Sant Parmanand Hospital, Delhi, India
Subhash C Arya
Sant Parmanand Hospital, 18 Alipore Road, Delhi-110 054
|How to cite this article:|
Arya SC, Agarwal N. Dengue fever in a patient recovering from coronary artery bypass grafting.Ann Card Anaesth 2011;14:245-245
|How to cite this URL:|
Arya SC, Agarwal N. Dengue fever in a patient recovering from coronary artery bypass grafting. Ann Card Anaesth [serial online] 2011 [cited 2020 Apr 5 ];14:245-245
Available from: http://www.annals.in/text.asp?2011/14/3/245/84041
We read with interest the report of dengue infection in a 62-year-old patient after being operated for triple-vessel left main coronary artery disease.  Our intention is to share the intriguing dengue virus infection profile during the late incubation phase as well as biology of the responsible vector.
Every patient would be viremic during the late incubation period as well as in the phase prior to the critical phase of the disease from the third to fifth day of the illness.  Such an individual would be teeming with dengue virus, which would be picked up by the bite of mosquito, Aedes aegypti, which is responsible for disease transmission.
The biology of vectors A. aegypti and A. albopictus, responsible for chikungunya fever, is intriguing. A. albopictus is an aggressive mosquito that bites in the day time, with peaks generally occurring during early morning and later afternoon. It is a container-inhabiting species that lays eggs in any water-containing receptacle in urban, suburban, rural, and forested areas.  The other member of the Aedes species, the A. aegypti, also usually bites in the early morning or late afternoon, but can also bite at night if there is sufficient artificial light. Aedes aegypti particularly bites near the ankles.
In order to guard against any dengue virus spread among patient in centers offering coronary artery bypass grafting,  therapeutic response in infected individuals should be accompanied by anti-mosquito measures. A mosquito net, insecticide fogging and search from breeding sites, and electric vapor mats incorporating insecticides should be offered. These steps would eliminate the possibility of spread of dengue virus from the hospitalized patients.
During the spurt of dengue fever in and around centers offering coronary artery bypass grafting, it would be rational to screen all prospective cases for dengue virus non-structural protein1 (NS1), which appears before anti-viral Immunoglobulin (Ig)M in primary infection or IgG in secondary infection. Point-of-care assay formats for detection of dengue virus NS1, IgM, and IgG would be a reasonable option.
The single-step immunochromatographic one-step dengue NS1 Ag and IgG/IgM test, (Dengue Duo; Standard Diagnostics, Inc, St. Ingbert, Germany: www.standard.com) was of immense utility during the 2010 dengue virus outbreak in Delhi, India. Among 175 suspected cases, 86 were NS1 positive and 89 were NS1 negative. Among 86 NS1-positive patients, 23 were IgM positive, 4 were IgG positive, and 6 were positive for all three markers. The 89 NS1-negative patients included two IgM-positive, eight IgG-positive, and seven IgM- and IgG- positive patients: 72 patients were negative for all three markers and 53 were positive exclusively for NS1. Using Dengue Duo test, it was possible to diagnose 61 additional patients: these NS1 positives included 57 who were negative for IgM and four who were positive for IgG only. 
Finally, the hospitals offering coronary artery bypass surgery  should incorporate regular dengue screening of their cases since many such cases might be domiciled in dengue-endemic foci. They might disseminate dengue virus in otherwise dengue-free hospitals offering coronary artery bypass surgery.
|1||Rawat S, Mehta Y, Juneja R, Trehan N. Dengue fever in a patient recovering from coronary artery bypass grafting. Ann Card Anaesth 2011;14:155-6.|
|2||Novak R. The Asian tiger mosquito, Aedes albopictus. Wing Beats. 1992;3:5.|
|3||Arya SC, Agarwal N, Parikh SC. Usefulness of detection of dengue NS1 antigen alongside IgM plus IgG, and concurrent platelet enumeration during an outbreak. Trans R Soc Trop Med Hyg 2011;105:358-9.|