RESUMO
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.
RESUMO
BACKGROUND: Dengue fever is the most common viral communicable disease caused by the bite of Aedes aegypti mosquito. Worldwide about 3.9 billion people are at the risk of this infection. MATERIALS AND METHODS: This prospective study was done in patients of dengue fever admitted in a service hospital in the coastal area of southern India from 01 Jan 2018 to 31 Dec 2018. RESULTS: 751 patients of confirmed dengue patients were admitted with 555 (73.9%) males and 196 (26.1%) females. The mean age was 30.6 (SD± 10.48) years, mean day of admission after the onset of illness was 3.4 days (SD±2.76). The most common presentation was fever (99.33%) followed by myalgia (77.62%), headache (67.24%), vomiting (35.41%), nausea (26.76%) and fatigue (9.05%). Bleeding diathesis was evident in 97patients (12.91%). 306 (40.75%) patients presented with warning signs. The mean duration of hospitalization was 5.73 (SD± 2.75) days. Four patients died due to severe dengue (mortality rate-0.53%). CONCLUSION: Intense monitoring, early detection, and management of complications can prevent mortality in dengue.