Written by Tabassum Barnagarwala |
August 15, 2015 12:56:02 am
August 15, 2015 12:56:02 am
Dr Om Srivastava
Dr Om Srivastava: Director, Infectious Diseases dept Jaslok Hospital, Mumbai
A 26-year-old resident doctor of a state-run teaching hospital was referred for an opinion on infectious diseases in 2014. He had a short history of illness, about four days of fever, rapidly evolving skin rash, worsening breathlessness and low platelets (count of 7,000). A diagnosis of dengue haemorrhagic fever was carried out. However, his medical parameters were declining rapidly, forcing us to put him on ventilator by day five. He had developed complications like cardiac tamponade, tense ascites and large bilateral pleural effusions.
Based on a rapidly worsening clinical condition, a rare decision to use immunoglobulins was taken after discussing risk factors with his family and the dean of the hospital.
Use of immunoglobulin, a protein, is ambiguous in treatment of dengue haemorrhagic fever.
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While the positives of immunoglobulins is the possibility that it could clear immune complexes in the body along with rise in platelet count, the cons can be leakage of capillaries or even worsening in body cavities. This treatment has not been documented well in case of dengue.
We decided to use it as all other treatment measures were failing.
By day three of administering immunoglobulin, all parameters began to show improvement and by the fifth day, he was significantly better. He was extubated on the tenth day and discharged a week later. The role of immunoglobulins in viral haemorrhagic fever is clearly defined, though not as clear in dengue hemorrhagic fever. This patient’s account illustrates that while there are defined boundaries in practice, patients with life-threatening infection should be assessed on an individual basis.
As told to Tabassum Barnagarwala
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