Roy Sayak
Internal Medicine, Calcutta Medical Research Institute Hospital, Kolkata, IND.
Cureus. 2019 Apr 1;11(4):e4361. doi: 10.7759/cureus.4361.
Dengue is considered the most prevalent mosquito-borne viral disease worldwide and sometimes turns out to be life-threatening. Thrombocytopenia is frequently observed in mild and severe cases of dengue. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue that needs proper and timely management. The development of the dengue vaccine is quite challenging due to the existence of four different serotypes of the virus. Currently, neither a specific antiviral therapy nor a vaccine is available, and the common treatment modalities include fluid replacement therapy and platelet transfusions. Besides dengue, thrombocytopenia is correlated with many other diseases, particularly immune thrombocytopenic purpura (ITP). Thrombopoietin receptor (TPO-R) agonist, which is responsible for increasing platelet count, is a novel treatment option for chronic ITP patients. At present, two TPO-R agonists - eltrombopag and romiplostim - approved by the US Food and Drug Administration (USFDA) have been successfully used for the treatment of chronic ITP and other thrombocytopenic conditions. However, to date, only a single case study reported the use of romiplostim to enhance the platelet count in a myeloma patient suffering from dengue-associated thrombocytopenia. The objective of this review is to propose to the medical fraternity to consider using these TPO-R agonists to treat dengue hemorrhagic patients with thrombocytopenia and to conduct relevant researches to find out the usefulness of these molecules. This review is completely based on hypotheses and articles showing the positive response with romiplostim in dengue after going through a web-based search on various search engines. Furthermore, this review highlights the need for good-quality, randomized controlled trials and meta-analyses to detect the safety and efficacy of romiplostim and eltrombopag therapy for patients suffering from dengue-related thrombocytopenia.
登革热被认为是全球最普遍的蚊媒病毒性疾病，有时会危及生命。血小板减少症在登革热的轻症和重症病例中都很常见。严重血小板减少症，即血小板计数远低于正常范围并伴有出血表现，被认为是登革热的致命后果，需要妥善及时的处理。由于该病毒存在四种不同血清型，登革热疫苗的研发颇具挑战。目前，既没有特异性抗病毒疗法，也没有疫苗，常见的治疗方式包括液体替代疗法和血小板输注。除了登革热，血小板减少症还与许多其他疾病相关，尤其是免疫性血小板减少性紫癜（ITP）。血小板生成素受体（TPO-R）激动剂负责增加血小板计数，是慢性ITP患者的一种新型治疗选择。目前，美国食品药品监督管理局（USFDA）批准的两种TPO-R激动剂——艾曲泊帕和罗米司亭，已成功用于治疗慢性ITP和其他血小板减少症。然而，迄今为止，仅有一项病例研究报道了使用罗米司亭提高一名患有登革热相关血小板减少症的骨髓瘤患者的血小板计数。本综述的目的是向医学界提议考虑使用这些TPO-R激动剂治疗登革热出血伴血小板减少症患者，并开展相关研究以确定这些分子的效用。本综述完全基于假设以及在各种搜索引擎上进行网络搜索后发现的显示罗米司亭对登革热有阳性反应的文章。此外，本综述强调需要高质量的随机对照试验和荟萃分析，以检测罗米司亭和艾曲泊帕疗法对登革热相关血小板减少症患者的安全性和有效性。
