Persistent thrombocytopenia following dengue fever. Thrombocytopenia in dengue fever is a common and very serious complication. Effects of filgrastim on thrombocytopenia in patients with. Dengue fever is the most prevalent mosquito borne viral disease in south and southeast asia. Health experts have known about dengue fever for more than 200 years. Thrombocytopenia is a common laboratory finding in dengue infection. In our study, dengue fever was distributed more among the young and middleaged population with 69% of the affected patients falling in the age group between 20 and 49 figure 1. Intravenous immunoglobulin for severe thrombocytopenia in. Transmission occurs through the bite of infected aedes mosquitoes, principally aedes aegypti, which is also the principal urban vector of yellow fever. Le van tuan 1, phan thi tuyet nga 1, trinh thi hong hanh 1. Managing a severe dengue infection is a challenge specially when complicated by other comorbidities. The patients were white women aged 32, 37, 40, 41, and 67 years in whom.
In november 2009, the world health organization who issued a new guideline that classifies symptomatic cases as dengue or severe dengue. Thrombocytopenia is common in patients with dengue virus denv infections. Dengue fever is transmitted by the bite of an aedes mosquito infected with a dengue virus. Department of health and human services centers for. Out of 334, 289 patients had dengue fever df and 45 patients had dengue haemorrhagic fever dhf. Corticosteroid responsive prolonged thrombocytopenia in a. The use of corticosteroids in the management of thrombocytopenia in dengue fever remains untested. Severe infection is characterized by a leakage phase or critical phase usually lasting 48 hours following an initial febrile phase. Suppression of marrow that affects both megakaryopoiesis and. Peripheral destruction and bone marrow suppression is seen in equal proportion of patients with dengue. To evaluate the outcome of thrombocytopenia with dengue.
Severe illness is characterized by hemodynamic disturbances, increased vascular permeability, hypovolemia, hypotension, and shock. Pdf management of dengue fever with severe thrombocytopenia. Dengue haemorrhagic fever is a potentially lethal illness that is universally prevalent in the tropics. Thrombocytopenia in dengue fever and the role of platelet. To test whether intravenous low dose dexamethasone is. Thrombocytopenia has always been one of the criteria used by who guidelines as a potential indicator of clinical severity 20, 31. Your doctor may recommend that you drink plenty of fluids to avoid dehydration from vomiting and a high fever. Dengue begins abruptly after an incubation period of 57 days range, 310 days, and the course follows 3 phases. Fever with headache and presence of thrombocytopenia, leukopenia, reversal of neutrophil lymphocyte ratio with signs of capillary leak like ascitis, pleural effusion and rising haematocrit should. Persistent thrombocytopenia is not a feature of dengue fever. Feb 16, 2018 no specific treatment for dengue fever exists.
An open labeled randomized controlled trial was carried out on 228 patients with df and dengue haemorrhagic fever dhf. Aug 15, 2001 dengue fever df is the most prevalent and expanding arboviral disease in humans, and its incidence is increasing. This disease used to be called breakbone fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking. Sep 15, 2015 all cases of dengue fever in the united kingdom have been acquired as a result of travel to endemic areas. Transmitted by aedes mosquitoes and epidemic in most tropical areas, the.
Dengue and thrombocytopenia connecting our members with. Bone marrow suppression by virus and peripheral destruction of platelets have been implicated. We report a patient with dengue haemorrhagic fever and spontaneous bleeding who required mandatory anticoagulation for a prosthetic mitral valve replacement. Thrombocytopenia in dengue hemorrhagic fever paediatrica. In general, dengue is a selflimiting acute febrile illness followed by a phase of critical defervescence, in which patients may improve or progress to a severe form. Of these, antid has shown promise in the treatment of severe thrombocytopenia in dhf patients while a pafr antagonist relieved thrombocytopenia in a mouse model of dengue infection. Managing a dengue infection with severe thrombocytopenia is a challenge especially when. This study was done to see how much prevalent is thrombocytopenia and need and indications of platelets transfusion in patients with dengue fever in our community hospitals. A rare case of pituitary apoplexy secondary to dengue. Sep 18, 2012 although hematological disorders with salient features of thrombocytopenia have been well documented in dengue patients, the role of cd61expressing platelets and the megakaryocytic cell lineage in the pathogenesis of dengue virus denv infection remains largely unexplored.
Dengue fever df is the most prevalent and expanding arboviral disease in humans, and its incidence is increasing. Diabetes mellitus increases severity of thrombocytopenia. The definition of dengue shock syndrome follows all of the above criteria for dengue hemorrhagic fever. Severe thrombocytopenia in dengue fever and vitamin b12. Fever with thrombocytopenia is the usual clinical presentation which may be complicated by haemorrhage and shock. Dhf is currently defined by the following four world health organization who criteria. Thrombocytopenia is one of the mo st important clinical. Dengue causes serious infection in humans, resulting in morbidity and. A prospective observational study of dengue fever with. Introduction dengue fever df and dengue hemorrhagic fever. Description of the clinical picture of dengue hemorrhagic feverdengue shock syndrome dhfdss in adults.
Diagnosis is important as corticosteroids rapidly improve the. While recovering from dengue fever, watch for signs and symptoms of dehydration. To test whether intravenous low dose dexamethasone is efficacious in increasing platelet count in acute severe thrombocytopenia in dengue infection. The study was conducted to investigate the platelet increasing property of carica papaya leaves juice cplj in patients with dengue fever df. Dengue fever symptoms, diagnosis and treatment bmj best. In addition to platelet activation, dengue infection has been found to activate the intrinsic pathway of apoptosis, with increased surface. Denv propagation in bone marrow 33,174,175 may contribute to suppression of hematopoiesis in all lineages. There are four dengue virus denv types denv1, denv2, denv3, and denv4, all of which are capable of inducing severe disease dengue hemorrhagic fever dhf dengue shock syndrome dss. May i please seek members views on the role of thrombocytopenia in diagnostics and therapeutics of dengue. Dengue chapter 4 2020 yellow book travelers health. Thrombocytopenia in patients with dengue virus infection.
Immune thrombocytopenic purpura itp also known as idiopathic thrombocytopenic purpura or immune thrombocytopenia is a hematological disorder resulting thrombocytopenia caused due to a primary or secondary autoimmune process 6. Thrombocytopenia was present in 234 81% df cases and 45 100% dhf cases. Dengue is an infectious disease caused by dengue virus denv. Background dengue causes significant morbidity and mortality in the tropical countries.
Thrombocytopenia in dengue infection raises concern about bleeding risk. Guidelines for treatment of dengue fever dengue haemorrhagic fever in small hospitals dengue is the most important emerging tropical viral disease of humans in the world today. Transmitted by aedes mosquitoes and epidemic in most tropical areas, the disease may have a high attack rate among people of any age, regardless of whether they are residents of or travelers to areas of endemicity. We undertook a placebo controlled study at the teaching hospital, peradeniya, sri lanka in july 2004. In the most recent 2009 who guidelines, the definitions generally describe a rapid decline in platelet count or a platelet count less than 150,000 per microliter of blood. Interrelationship between virus and the imbalance between coagulation and fibrinolysis and inflammatory mediators elzinandeslealdeazeredo,1 robsonq. Dengue and thrombocytopenia by sandeep saluja 24 jun, 2017. Dengue chapter 4 2020 yellow book travelers health cdc. Chikungunya virus more likely to cause high fever, severe polyarthralgia, arthritis, rash, and lymphopenia dengue virus more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death patients with suspected chikungunya should be managed as dengue until dengue has been ruledout. A dengue serological test was performed on 1,100 85% of the patients with a positive result in 763 69%, hi test on 243 patients 22%, igg dengue blot on 489 patients 44% and igm dengue blot on 25 patients 2. Platelet activation determines the severity of thrombocytopenia in. Dengue is probably the most important arthropodborne viral disease in terms of human morbidity and mortality. He received a total of 10 units of sdp to maintain the platelet counts. Thrombocytopenia in patients with dengue virus infection and correlation between circulating soluble micb protein level and platelet counts.
With a focus on understanding the possible mechanism of thrombocytopenia in denv infections we described a direct. In cases of dengue hemorrhagic fever, thrombocytopenia. Jan 27, 2016 introduction dengue and dengue hemorrhagic fever dhf result from infection by any of four serotypes of dengue viruses. Dengue fever is a mosquitoborne tropical disease caused by the dengue virus. There are four dengue virus denv types denv1, denv2. Dengue fever causes thrombocytopenia, which, in turn, can precipitate pa. Usually thrombocytopenia resolves and platelet count normalises by day 10 of fever.
Pituitary apoplexy secondary to thrombocytopenia due to. During the leakage phase, an increase in capillary permeability leads to extravasation of fluid and haemoconcentration. Dengue is considered the most prevalent mosquitoborne viral disease worldwide and sometimes turns out to be lifethreatening. Thrombocytopenia and platelet dysfunction are common in both cases and are related to. Dengue hemorrhagic fever can occur when someone is bitten by a mosquito or exposed to blood infected with the dengue virus. Clinical and serologic study of cuban children with dengue hemorrhagic feverdengue shock syndrome dhfdss. Jan 31, 2017 thrombocytopenia is common in patients with dengue virus denv infections. Thrombocytopenia and platelets transfusion in dengue fever. Call your doctor right away if you develop any of the following. Pdf dengue has established itself as one of the worlds most common mosquitoborne viral diseases. Carica papaya leaves juice significantly accelerates the rate.
Corticosteroidresponsive prolonged thrombocytopenia. However, it usually resolves as the patient recovers from the infection. Data of 51 patients with dengue fever with thrombocytopenia, or. This prospective observationl study was done in dengue fever patient with severe prolonged. Here we present a case of severe dengue with refractory thrombocytopenia that responded to intravenous immunoglobulin ivig. Here you can read posts from all over the web from people who wrote about dengue fever and thrombocytopenia, and check the relations between dengue fever and thrombocytopenia. It is estimated that there are between 50 and 100 million cases of dengue fever df and about. Vitamin b12, vitamin c, and iron are just some of the supplements you should be including in your diet to increase your platelet count. For next four weeks, he had persisting intermittent fever spikes without any focus of infection.
Chikungunya virus more likely to cause high fever, severe polyarthralgia, arthritis, rash, and lymphopenia dengue virus more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death. Patients with dengue hemorrhagic fever and dengue shock syndrome were excluded. S ir during the 2002 dengue hemorrhagic fever dhf outbreak in brazil, we treated 5 patients in recife with dhf. Introduction dengue and dengue hemorrhagic fever dhf result from infection by any of four serotypes of dengue viruses.
Looking for ways to naturally increase your platelet count. Thrombocytopenia and platelet dysfunction are common in both cases. The mosquito becomes infected when it bites a person with dengue virus in their blood. In 763 69% of them evidence was found of a present or previous dengue infection. Dec 12, 2017 looking for ways to naturally increase your platelet count. With a focus on understanding the possible mechanism of thrombocytopenia in denv infections we. Dengue hemorrhagic fever and severe thrombocytopenia in a. Serious thrombocytopenia due to dengue hemorrhagic fever. Persistent thrombocytopenia in dengue hemorrhagic fever medind. Thrombocytopenia is frequently observed in mild and severe cases of. A case of acute idiopathic thrombocytopenia purpura following dengue haemorrhagic fever is described. Severe infection is characterized by a leakage phase or critical phase usually lasting 48. Severe dengue fever is characterized by marked thrombocytopenia, severe hemorrhage, plasma leakage leading to shock or fluid accumulation with respiratory distress, and severe organ impairment. L, severe bleeding was uncommon irrespective of the use of prophylactic platelet transfusion, confirming that careful observation is the preferred approach for these patients since most clinical bleeding was mild and selfresolving.
The patients were white women aged 32, 37, 40, 41, and 67 years in whom dhf had been diagnosed on the basis of clinical and serological elisa with a positive igm result findings. Besides platelet apoptosis and aggregation at the periphery, central mechanisms of bone marrow suppression may also contribute to thrombocytopenia in dengue 172, 173. Transmission occurs through the bite of infected aedes. Symptoms typically begin three to fourteen days after infection. Managing a dengue infection with severe thrombocytopenia is a challenge especially when complicated by other comorbidities. Confirmatory tests include viral antigen or nucleic acid detection and serology. However, no specific treatment is available for dengue fever induced thrombocytopenia.
Severe infection is characterized by a leakage phase or critical phase. A slight decrease in the platelet count does not contribute to the disease but when it is below 50,000 per microliter, thrombocytopenia occurs. Among the mechanisms underlying thrombocytopenia in dengue are. Dengue is a febrile illness caused by a flavivirus transmitted by aedes aegypti or aedes albopictus mosquitoes while taking a blood meal. Moderate to marked thrombocytopenia with concurrent haemoconcentration is a distinctive clinical laboratory. Thrombocytopenia and bleeding manifestations are consistent features of dengue fever.
Interrelationship between virus and the imbalance between coagulation and fibrinolysis and inflammatory mediators elzinandeslealdeazeredo, 1. In general, dengue is a selflimiting acute febrile illness followed by a phase of critical defervescence, in which patients may improve or. Infections and thrombocytopenia journal of association. Persistent thrombocytopenia following dengue infection requires further investigation. A prospective observational study was performed using blood samples and pbmcs from dengue confirmed patients, as well as. Thrombocytopenia may occur in patients with either mild or severe cases of dengue infection and are associated in the early days of dengue infection 1. To present a case of pituitary apoplexy secondary to thrombocytopenia associated with dengue hemorrhagic fever dhf. Thrombocytopenia and platelet transfusions in dengue. The presence of thrombocytopenia was determined in 1,300 patients with dengue haemorrhagic fever dhf 1,198.
The health protection agency reported 406 cases of dengue fever in england, wales, and northern ireland in 2010, compared with 166 in 2009. The presence of thrombocytopenia was determined in 0 patients with clinically suspected dengue haemorrhagic fever dhf 1198. These data suggest that treatment of severe thrombocytopenia accompanying dhf with antid may be a useful and safe therapeutic option. A dengue serological test was performed on 1100 85% of the 0 patients. By contrast, ivig did not hasten the recovery of thrombocytopenia in dengue patients with secondary dv infection. Dengue haemorrhagic fever typical cases of dhf are characterized by four major clinical manifestations. Dengue haemorrhagic fever 12 chapter 2 clinical diagnosis dengue virus infections may be asymptomatic or may lead to undifferentiated fever, dengue fever df or dengue haemorrhagic fever. Dengue and dengue hemorrhagic fever 1 dengue and dengue hemorrhagic fever information for health care practitioners dengue is a mosquitoborne disease caused by any one of four closely related dengue viruses denv1, 2, 3, and 4. Jun 15, 2003 s ir during the 2002 dengue hemorrhagic fever dhf outbreak in brazil, we treated 5 patients in recife with dhf. Proposed mechanisms behind thrombocytopenia are many. Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses.
Efficacy of low dose dexamethasone in severe thrombocytopenia. Infection with one serotype of denv provides immunity to that. Dengue fever is a globally important arboviral infection transmitted by the aedes genus of mosquito primarily a aegypti, but also a albopictus, found in tropical and subtropical. Direct platelet destruction by dengue virus, immunemediated platelet destruction and even megakaryocytic.
Approximately half the patients received the juice, for 3 consecutive days while the others remained as controls and. Vitamin b12, vitamin c, and iron are just some of the supplements you should be including in your diet to increase your platelet. In 2015, north india had the most recorded number of cases in the last decade. In dengue fever with thrombocytopenia platelet transfusion is given because of the patient relatives social pressure on treating physician rather than the medical indication.
735 93 1233 21 145 584 515 636 1142 200 412 1086 1431 1419 1368 745 216 886 185 75 172 336 147 1351 1269 592 1446 1020 82 31 1112 89 701 477 470 1178