Effect of single dose methyl prednisolone in severe illness associated with dengue fever

Abstract

INTRODUCTION AND OBJECTIVES: Role of steroids in the management of severe illness associated with dengue fever (SIDF) remains controversial. However, steroids are widely used in severe dengue. METHODS: Patients admitted to Professorial Medical Unit, CNTH, with SIDF during the recent dengue fever outbreak, a single dose intravenous methylprednisolone (MP) was administered as a rescue measure. Clinical and management data of 18 such patients (6 males) who were treated with MP (Group A) are presented here. [Definition of SIDF: fever >100F persisting after the fourth day of illness, without evidence of secondary bacterial infection together with a systolic BP <100mmHg and a postural drop of >20mmHg and the presence of or rapidly developing ascites or pleural effusions]. Fresh frozen plasma (FFP) rather than crystalloids were used to prevent worsening of third space fluid loss and pulmonary oedema on recovery. RESULTS: The mean(SD) age [yrs] 29 (11), and clinical parameters when SIDF was detected; duration of illness[days]: 5.6(1.9), fever[F]; 102(1) , systolic BP[mmHgj; 91(12), Hb[g/dl]: 14.2(3.1), PCVjTTJ: 42(7.2), platelets[xlOy/L]: 25(13), and resuscitation parameters; crystalloids [L/Kg]: 0.32(0.1), FFP[u]: 2(1.1). deaths: 0/18, time to defervasence[days); 1(2)], time to haemodynamic stability[Hrs]: 5.8(5.8), number needing ICU care 5/18. CONCLUSIONS: These preliminary observations appear to suggest beneficial effects of timely given single dose MP in the management of SIDF.