Effect of steroid on platelet count of dengue patients admitted at Sapthagiri Institute of Medical Sciences and Research Centre: a retrospective study
Keywords:Dengue, Dexamethasone, Low dose steroid, Mean platelet count
Background: New treatment strategies are attempted to treat the fatal complications of the dengue infection, as significant numbers of adult and children are affected resulting in considerable economic impact. Corticosteroids in various regimens have been used in the last 2 decades empirically on the basis of immunomodulation or treat the vascular leakage that occurs in severe dengue.
Methods: A descriptive study was conducted among 60 patients who were dengue positive and received treatment from the Department of Medicine at SIMSRC during the period of June-August 2018. The study group (30 patient) was given treatment with intravenous dexamethasone 8 mg initially, followed by 4 mg TID for 3 days. The control group (30 patient) received only IV fluids and antipyretics. The rise in the mean platelet counts over three days was analyzed in both groups were analyzed.
Results: The results of this study revealed that after 10-12 hours of initiating steroids in the study group, a higher and early rise of platelet count was achieved. There was gradual improvement and increase in platelets in 3 days’ duration in all 30 of the patients. The mean platelet count (the primary outcome) in the study group was significant compared with the control group.
Conclusions: At present, realistic approaches for the early intervention and proper treatment protocol are required to be developed to prevent high mortality and morbidity due to dengue. The drawback of this study was, it was not a double-blind placebo-controlled trial and there were less number of patients.
World Health Organization, Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva, Switzerland: World Health Organization; 2009.
Kularatne SA. Survey on the management of dengue infection in Sri Lanka: opinions of physicians and pediatricians. South Asia J Trop Medi Pub Health. 2005;36(5):1198.
Panpanich R, Sornchai P, Kanjanaratanakorn K. Corticosteroids for treating dengue shock syndrome. Cochr Data Syst Rev. 2006(3).
Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. In Mayo Clin Pro. 2004;79(4):504-22.
Futrakul P, Poshyachinda MA, Mitrakul CH, Kwakpetoon SM, Unchumchoke PO, et al. Hemodynamic response to high-dose methyl prednisolone and mannitol in severe dengue-shock patients unresponsive to fluid replacement. South Asian J Trop Medi Pub Health. 1987;18(3):373-9.
Chappell D, Jacob M, Hofmann-Kiefer K, Bruegger D, Rehm M, Conzen P, et al. Hydrocortisone preserves the vascular barrier by protecting the endothelial glycocalyx. J Am Soci Anesthesiol. 2007;107(5):776-84.
Shashidhara KC, Murthy KS, Gowdappa HB, Bhograj A. Effect of high dose of steroid on plateletcount in acute stage of dengue fever with thrombocytopenia. J Clini Dia Res. 2013;7(7):1397.
Pasha A, Ahmed SB. Role of low dose hydrocortisone in the management of viral thrombocytopenia. Int J Pharma Medi Biol Sci. 2014;3(3):95.
Halstead SB. Antibody, macrophages, dengue virus infection, shock, and hemorrhage: a pathogenetic cascade. Rev Infect Dis. 1989;11(4):S830-9.
Green S, Vaughn DW, Kalayanarooj S, Nimmannitya S, Suntayakorn S, Nisalak A, et al. Early immune activation in acute dengue illness is related to development of plasma leakage and disease severity. J Infect Dis. 1999;179(4):755-62.