K V Padmaprakash1, V K Jha2, C Sowmya Karantha3, Chauhan Anurag Singh4, Deep Kamal5, Prashant Jambunathan6. 1. Senior Advisor & Head (Medicine & Gastroenterology), INHS Kalyani, Visakhapatnam, India. 2. Classified Specialist (Medicine & Nephrologist), Command Hospital (Air Force), Bengaluru, India. 3. Medical Officer, ECHS Polyclinic, Visakhapatnam, India. 4. Senior Advisor (Medicine), INHS Kalyani, Visakhapatnam, India. 5. Classified Specialist (Medicine), INHS Kalyani, Visakhapatnam, India. 6. Graded Specialist (Medicine), INHS Kalyani, Visakhapatnam, India.
Abstract
Background: Severe dengue causes more than 22,000 deaths annually worldwide. Complicated dengue has high mortality of 44-72%. Disordered immune system with capillary leak and thrombocytopenia are hallmark of complicated dengue. Intravenous immunoglobulin (IV Ig) therapy has shown to be effective in complicated dengue in pediatric age group with refractory shock, but studies in adults are lacking. Its immunoresuscitative role is not yet fully explored in critically ill patients with severe dengue. Methods: This is retrospective observational study of patients with complicated dengue fever who were administered IV Ig therapy in a tertiary care hospital of southern India from 01 Jan 2018 to 31 Dec 2019. Results: A total of 999 patients with dengue were admitted; 754 (75.47%) were males, and 245 (24.53%) were females. A total of 402 (40.24%) patients presented with warning signs. Bleeding was seen in 121 patients (12.11%); 102 (10.21%) had shock; 29 (2.90%) had acute kidney injury and 24 (2.40%) had adult respiratory distress syndrome. Overall, four people died (mortality rate: 0.40%). IV Ig in the dose of 0.4 g/kg for 5 days was used in 13 critically ill patients where standard therapy failed, 9 patients with refractory shock (which included three with myocarditis with refractory shock), 2 with encephalitis, 2 in hemophagocytic lymphohistiocytosis. Two patients died, one with myocarditis with refractory shock and another with refractory shock. Conclusion: IV Ig therapy in critically ill patients with complicated dengue can be used as a rescue therapy.
Background: Severe dengue causes more than 22,000 deaths annually worldwide. Complicated dengue has high mortality of 44-72%. Disordered immune system with capillary leak and thrombocytopenia are hallmark of complicated dengue. Intravenous immunoglobulin (IV Ig) therapy has shown to be effective in complicated dengue in pediatric age group with refractory shock, but studies in adults are lacking. Its immunoresuscitative role is not yet fully explored in critically ill patients with severe dengue. Methods: This is retrospective observational study of patients with complicated dengue fever who were administered IV Ig therapy in a tertiary care hospital of southern India from 01 Jan 2018 to 31 Dec 2019. Results: A total of 999 patients with dengue were admitted; 754 (75.47%) were males, and 245 (24.53%) were females. A total of 402 (40.24%) patients presented with warning signs. Bleeding was seen in 121 patients (12.11%); 102 (10.21%) had shock; 29 (2.90%) had acute kidney injury and 24 (2.40%) had adult respiratory distress syndrome. Overall, four people died (mortality rate: 0.40%). IV Ig in the dose of 0.4 g/kg for 5 days was used in 13 critically ill patients where standard therapy failed, 9 patients with refractory shock (which included three with myocarditis with refractory shock), 2 with encephalitis, 2 in hemophagocytic lymphohistiocytosis. Two patients died, one with myocarditis with refractory shock and another with refractory shock. Conclusion: IV Ig therapy in critically ill patients with complicated dengue can be used as a rescue therapy.
Authors: Efren M Dimaano; Mariko Saito; Shoko Honda; Edna A Miranda; Maria T G Alonzo; Myra D Valerio; Cynthia A Mapua; Shingo Inoue; Atsushi Kumaori; Ronald Matias; Filipinas F Natividad; Kazunori Oishi Journal: Am J Trop Med Hyg Date: 2007-12 Impact factor: 2.345
Authors: Jeffrey D Stanaway; Donald S Shepard; Eduardo A Undurraga; Yara A Halasa; Luc E Coffeng; Oliver J Brady; Simon I Hay; Neeraj Bedi; Isabela M Bensenor; Carlos A Castañeda-Orjuela; Ting-Wu Chuang; Katherine B Gibney; Ziad A Memish; Anwar Rafay; Kingsley N Ukwaja; Naohiro Yonemoto; Christopher J L Murray Journal: Lancet Infect Dis Date: 2016-02-10 Impact factor: 25.071
Authors: Esther M Ellis; Tyler M Sharp; Janice Pérez-Padilla; Liza González; B Katherine Poole-Smith; Emmaculate Lebo; Charlotte Baker; Mark J Delorey; Brenda Torres-Velasquez; Eduardo Ochoa; Brenda Rivera-Garcia; Hector Díaz-Pinto; Luis Clavell; Anabel Puig-Ramos; Gritta E Janka; Kay M Tomashek Journal: PLoS Negl Trop Dis Date: 2016-08-24