Padmaprakash K V, Jha V K, Sowmya Karantha C, Anurag Singh Chauhan, Kamal Deep, Jambunathan Prashant
Senior Advisor & Head (Medicine & Gastroenterology), INHS Kalyani, Visakhapatnam, India.
Classified Specialist (Medicine & Nephrologist), Command Hospital (Air Force), Bengaluru, India.
Med J Armed Forces India. 2022 Apr;78(2):204-212. doi: 10.1016/j.mjafi.2020.12.036. Epub 2021 Mar 26.
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.
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.
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.
IV Ig therapy in critically ill patients with complicated dengue can be used as a rescue therapy.
全球范围内，严重登革热每年导致超过22,000人死亡。复杂型登革热的死亡率高达44%-72%。免疫系统紊乱伴毛细血管渗漏和血小板减少是复杂型登革热的标志。静脉注射免疫球蛋白（IV Ig）治疗已被证明对患有难治性休克的儿童复杂型登革热有效，但缺乏针对成人的研究。在重症严重登革热患者中，其免疫复苏作用尚未得到充分探索。
这是一项回顾性观察研究，对象为2018年1月1日至2019年12月31日在印度南部一家三级护理医院接受IV Ig治疗的复杂型登革热患者。
共收治999例登革热患者；男性754例（75.47%），女性245例（24.53%）。共有402例（40.24%）患者出现警示体征。121例患者（12.11%）有出血症状；102例（10.21%）出现休克；29例（2.90%）发生急性肾损伤，24例（2.40%）出现成人呼吸窘迫综合征。总体而言，4人死亡（死亡率：0.40%）。13例重症患者在标准治疗失败后使用了剂量为0.4 g/kg、持续5天的IV Ig，其中9例为难治性休克患者（包括3例伴有难治性休克的心肌炎患者），2例为脑炎患者，2例为噬血细胞性淋巴组织细胞增生症患者。2例患者死亡，1例死于伴有难治性休克的心肌炎，另1例死于难治性休克。
IV Ig治疗可用于重症复杂型登革热患者的抢救治疗。
