A prospective observational study of dengue fever with thrombocytopenia with reference to treatment

Shashidhara Kuppegala Chikkaveeraiah; Rajashekar Reddy; Arun Kumar

doi:10.18203/2320-6012.ijrms20160540

Authors

Shashidhara Kuppegala Chikkaveeraiah Department of Medicine, J.S.S Medical College, JSS University, Ramanuja Road, Mysore-570004, Karnataka
Rajashekar Reddy Department of Medicine, J.S.S Medical College, JSS University, Ramanuja Road, Mysore-570004, Karnataka
Arun Kumar Department of Medicine, J.S.S Medical College, JSS University, Ramanuja Road, Mysore-570004, Karnataka

DOI:

https://doi.org/10.18203/2320-6012.ijrms20160540

Keywords:

Dengue haemorrhagic fever (DHF), Dengue shock syndrome (DSS), Thrombocytopenia, Fever

Abstract

Background: Dengue fever is treated according to the WHO guidelines worldwide but due to the unavailability of blood products and economic constraints treating physicians often modify according to the patients requirements and try to give best available treatment for the patients. So we did an observational study of dengue fever and evaluated the clinical profiles and prognosis of dengue fever with reference to the treatment in JSS Medical College, Mysore in south India, a tertiary medical centre.

Methods: This two year prospective, observational study was conducted in JSS Medical College. A total of 128 patients were evaluated and were divided into three groups like group 1-mild risk, group 2-moderate risk and group 3-high risk depending on the platelet count levels and bleeding diathesis. Group 1 received supportive treatment, group 2 received supportive treatment and steroids (Inj dexamethasone 4mg IV q8h) and group 3 received supportive treatment with steroids and platelet transfusion. Clinical evaluation and relevant investigations like blood culture; malarial parasites and febrile serology (acute and convalescent) were performed.

Results: This observational study revealed that dengue fever can be managed symptomatically according WHO guidelines and platelet transfusion is done only when platelet count is less than 10000/cumm or in bleeding diathesis irrespective of platelet count.

Conclusions: Steroid usage alone or along with platelet transfusion had no effect on the platelet count or on the overall outcome of the patient.

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References

WHO. Dengue guideline for diagnosis, treatment, prevention and control. Geneva: World Health Organization; 2009.

Guzman MG, Kauri G. Dengue: an update. The Lancet. Infect Dis. 2002;2:33-42.

Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc. 2004;79:504-22.

Messer WB, Vitarana UT, Sivananthan K, Elvtigala J, Preethimala LD, Ramesh R et al. Epidemiology of dengue in Sri Lanka before and after the emergence of epidemic dengue haemorrhagic fever. Am J Trop Med Hyg. 2002;66:765-73.

Kularatne SAM. Survey on the management of dengue infection in Sri Lanka: opinion of physicians and pediatricians. Southeast Asian J Trop Med Pub Health. 2005;36:1198-200.

Panpanich R, Sornchai P, Kanjanaratanakorn K. Corticosteroids for treating dengue shock syndrome. Cochrane Data Sys Rev. 2006;3:CD003488.

Lee VJ, Lye DCB, Sun Y, Fernandez G, Ong AK, Leo YS. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol. 2008;42:34-9.

Leong KW, Srinivas P. Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever. Med J Malaysia. 1993;48:369-72.

Dimaano EM, Saito M, Honda S, Miranda EA, Alonzo MT, Valerio MD et al. Lack of efficacy of high-dose intravenous immunoglobulin treatment of severe thrombocytopenia in patients with secondary dengue virus infection. Am J Trop Med Hyg, 2007;77(6):1135-8.

Lee MS, Hwang KP, Chen TC, Lu PL, Chen TP Clinical characteristics of dengue and dengue haemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J Microbiol Immunol Infect. 2006;39:121-9.

Min M, U T, Aye M, Shwe TN, Swe T. Hydrocortisone in the management of dengue shock syndrome. Southeast Asian J Trop Med Public Health. 1975;6:573-9.

Sumarmo, Talogo W, Asrin A, Isnuhandojo B, Sahudi A. Failure of hydrocortisone to affect outcome in dengue shock syndrome. Pediatrics 1982;69(1):45-9.

Tassniyom S, Vasanawathana S, Chirawatkul A, et al. Failure of high-dose methylprednisolone in established dengue shock syndrome: a placebo-controlled, double-blind study. Pediatrics 1993;92:111.

Futrakul P, Poshyachinda M, Mitrakul C, et al. Hemodynamic response to high-dose methyl prednisolone and mannitol in severe dengue-shock patients unresponsive to fluid replacement. Southeast Asian J Trop Med Public Health 1987; 18:373-9.

Epidemiological news bulletin: management of guidelines for dengue patients at Tan Tock Seng Hospital and communicable diseases center, Singapore. Platelet Transfusion. 2005;49.

Teik OC. A guide to DHF/DSS Management. Dengue Bull. 2001;25:48.

Makroo RN, Raina V, Kumar P, Kanth RK. Role of platelet transfusion in the management of dengue patients in a tertiary care. Asian J Transfus Sci. 2007;1(1):4-7.

Kumar ND, Tomar V, Singh B, Kela K. Platelet transfusion practice during dengue fever epidemic. Indian J Pathol Microbiol. 2000;43:55-60.

The Rationale Use of Platelet Transfusion in Dengue transfusion newsletter, 8th edition

Lum LC, Abdel-Latif Mel-A, Goh AY, Chan PW, Lam SK. Preventive transfusion in DSS - is it necessary? J Pediatr. 2003;143:682-4.

Lye DC, Lee VJ, Sun Y, Leo YS. Lack of Efficacy of Prophylactic Platelet Transfusion for Severe Thrombocytopenia in Adults with Acute Uncomplicated Dengue Infection. Clin Infect Dis. 2009;48(9):1262-5.

Assir M.Z.K.A, Kamran U.A, Ahmad H.I.B, Bashir S.A, Mansoor H.A, Anees S.B.A, Akram J.C.Effectiveness of platelet transfusion in dengue fever: a randomized controlled trial. A department of medicine, division of nephrology, MBBS, FRCP, professor of medicine, Allama Iqbal medical college/Jinnah hospital Lahore, Lahore, Pakistan, 2013.

Gupta E, Dar L, Narang P, Srivastava VK, Broor S. Sero diagnosis of dengue during an outbreak at a tertiary care hospital in Delhi. Indian J Med Res. 2005;121:36-8.

Minneci PC, Deans KJ, Eichacker PQ, Natanson C.The effects of steroids during sepsis depend on dose and severity of illness: an updated meta-analysis. Clin Microbiol Infect. 2009;15:308-18.

Sprung CL, Caralis PV, Marcial EH, Pierce M, Gelbard MA, Long WM et al. The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med. 1984;311:1137-43.

Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987;317:653-58.

The veterans’ administration systemic sepsis cooperative study group: Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med. 1987;317:659-65.

Lefering R, Neugebauer EAM. Steroid controversy in sepsis and septic shock: a metaanalysis. Crit Care Med. 1995;23:1294-303.

Cronin L, Cook DJ, Carlet J, Heyland DK, King D, Lansang MA. Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med. 1995;24:1430-39.

The trial to reduce alloimmunization to platelets study group. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N Engl J Med. 1997;337:1861-9.