Corticosteroid responsive prolonged thrombocytopenia in a case of dengue fever

Verma, Shailendra Prasad; Hamide, Abdoul; Wadhwa, Jyoti; Sivamani, Kalaimani

doi:10.1136/bcr-2013-200249

Cited by 6 publications

(12 citation statements)

References 7 publications

(6 reference statements)

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“…Thrombocytopenia was a consistent feature of DF and almost always found in DHF/SS, and usually, platelet count normalizes by day 10 of fever. Very few cases were reported worldwide having prolonged thrombocytopenia beyond day 10 . Dengue HLH should be suspected in any patient with persistent thrombocytopenia who has a history of fever in recent past.…”

Section: Discussionmentioning

confidence: 92%

“…Prolonged thrombocytopenia was noticed in this systematic review with a pooled rate of 55.6%. Thrombocytopenia was a consistent feature of DF and almost always found in DHF/SS, 44,45 and usually, platelet count normalizes by day 10 of fever. Very few cases were reported worldwide having prolonged thrombocytopenia beyond day 10.…”

Section: Discussionmentioning

confidence: 95%

“…Very few cases were reported worldwide having prolonged thrombocytopenia beyond day 10. 44,46 Dengue HLH should be suspected in any patient with persistent thrombocytopenia who has a history of fever in recent past.…”

Section: Discussionmentioning

confidence: 99%

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Dengue hemophagocytic syndrome: A systematic review and meta‐analysis on epidemiology, clinical signs, outcomes, and risk factors

Giang

Banno

Minh

et al. 2018

Reviews in Medical Virology

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We systematically searched and meta-analyzed the epidemiological characteristics, frequency of clinical signs, and outcomes of dengue-associated hemophagocytic lymphohistiocytosis. Ten electronic databases were searched systematically plus manual search of reference lists to identify relevant articles published until May 2017. The highest number of reported cases were from South-East Asia region (62 cases), followed by Western Pacific region (20 cases), and America (31 cases). The term "dengue hemorrhagic fever" predominated in studies that used the World Health Organization 1997 definition (59.7%), whereas "severe dengue" predominated in studies using the World Health Organization 2009 definition (76.8%). Among 122 cases, fever, splenomegaly, hepatomegaly, anemia, thrombocytopenia, and serum ferritin ≥500 μg/L were likely to report by articles representing by large sample size. The pooled proportion of these findings were as follows: fever 97.2%, hepatomegaly 70.2%, splenomegaly 78.4%, thrombocytopenia 90.1%, anemia 76.0%, and serum ferritin ≥500 μg/L 97.1%. This study highlighted a high case fatality rate (14.6%) and co-infection among dengue hemophagocytic lymphohistiocytosis patients. We suggest that long fever duration, persistent thrombocytopenia, elevated serum ferritin, and lactate dehydrogenase levels could be good diagnostic indicators for dengue-associated hemophagocytic syndrome. Bone marrow aspiration could be used as one criterion for diagnosis but is not obligatory. Further research is needed to examine the possible risk difference for development of hemophagocytic syndrome and to explore potential relationships between specific dengue classifications and dengue-associated hemophagocytic syndrome.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 95%

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Dengue hemophagocytic syndrome: A systematic review and meta‐analysis on epidemiology, clinical signs, outcomes, and risk factors

Giang

Banno

Minh

et al. 2018

Reviews in Medical Virology

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“…13,14 Conversely majority of the clinical studies have failed to demonstrate this benefit. 15 Future studies segregating the patients with thrombocytopenia with different mechanisms and targeting the treatment may provide the answers to the dogma of steroid usage in dengue infection.…”

Section: Discussionmentioning

confidence: 99%

Peripheral cell line suppression in dengue infection in relation to serological status

2016

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Background: Dengue infection occurs in epidemic and can be fatal. Bleeding due to thrombocytopenia and hypovolemic shock due to capillary leak is the predominant clinical feature. Bone marrow suppression as a cause of thrombocytopenia and neutropenia is well documented. This is generally recognised as decrease in the count of formed elements in the peripheral blood. However, relation of such a phenomenon with the serological stage of the disease is less studied. Aims and Objective: We aimed to quantify the magnitude of peripheral cell line suppression in relation to serological status of dengue illness. Materials and Methods: This was a retrospective study. Dengue infection was diagnosed by clinical and serological parameters.The proportion of patients with peripheral cell line suppression and their association with the different serological phases was described. Results: Records of 219 Dengue positive patients were analysed retrospectively. Most common serological status was positive IgG which was noted in 68.9%, this was followed by NS1 antigen positivity in 39.7% of the patients. Around 40% of the patients had peripheral cell line suppression of two or more formed elements at the time of diagnosis. Sixty-four percent of them had low platelet and WBC counts. All the three formed elements were decreased in 14% of our patients. Of these, 23% were in the initial phase of the illness and 33.3% during post primary phase. Conclusion: Decrease in the formed elements in the peripheral blood suggesting bone marrow suppression is seen in nearly 40% of the patients with Dengue infection at the time of diagnosis. This was highest during post primary phase followed by initial phase of the illness.

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“…Thrombocytopenia itself has been used as a surrogate for impact on dengue progression in various therapeutic trials without any agents identified as successful in significantly improving platelet recovery in acute infection, as in, for example, high-dose intravenous immunoglobulin [ 81 ]. In a few cases, however, unusually persistent thrombocytopenia lasting far beyond the usual convalescent recovery period has been successfully treated with corticosteroids [ 135 , 136 ].…”

Section: Systems-based Managementmentioning

confidence: 99%

Dengue: Moving from Current Standard of Care to State-of-the-Art Treatment

Gan

2014

Curr Treat Options Infect Dis

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Opinion statementTreatment of dengue remains supportive in the absence of targeted antiviral therapy or approved vaccines. Responsive fluid management is key to preventing progression to shock or other severe manifestations. The dynamic natural history of dengue infection and its influence on hemodynamic homeostasis needs to be carefully considered in the planning of individualized therapy. Though largely self-limiting, the sheer burden of dengue disease on the global population will result in atypical manifestations especially in children, older adults, and comorbid patients. Management of these has not yet been systematized. The failure of recent randomized controlled trials to show utility for antiviral and immunomodulatory agents in dengue is disappointing. Vaccine candidates hold promise, but growing outbreaks require more robust, evidence-based management guidelines to inform clinicians, especially in novel epidemic situations.

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Corticosteroid responsive prolonged thrombocytopenia in a case of dengue fever

Cited by 6 publications

References 7 publications

Dengue hemophagocytic syndrome: A systematic review and meta‐analysis on epidemiology, clinical signs, outcomes, and risk factors

Dengue hemophagocytic syndrome: A systematic review and meta‐analysis on epidemiology, clinical signs, outcomes, and risk factors

Peripheral cell line suppression in dengue infection in relation to serological status

Dengue: Moving from Current Standard of Care to State-of-the-Art Treatment

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