Abstract
Corticosteroids are used therapeutically for a broad spectrum of diseases including autoimmune, allergic and inflammatory diseases. However in trials, the evidence for using corticosteroids in dengue is inconclusive and the quality of evidence is low. This systemic review is conducted to review clinical trials on dengue and steroid therapy to identify the current strength and weakness of evidence for the use of corticosteroids.We searched MEDLINE/PUBMED and Google scholar for publications on steroid use in dengue and the relevant authors of the study were contacted for additional information, as required. This review includes thirteen studies enrolling 1293 children and adult participants. There was no evidence of viremia and no significant side effects after the administration of low and high doses of oral corticosteroids and high doses of intravenous corticosteroids. Beneficial therapeutic effects were seen in some studies, which used high doses or multiple doses of steroids.The effectiveness of corticosteroids in dengue is depended upon sustained therapeutic blood levels of corticosteroids for an adequate duration and using a steroid with higher receptor affinity. Further clinical trials using pharmacologically and immunologically accepted standard steroid protocols are warranted to validate this conclusion.
Highlights
World Health Organization (WHO) has published guidelines for the management of dengue fever
This study found that there was a reduction in the incidence of bleeding and ascites with steroids
Using intravenous hydrocortisone during this stage has shown no benefit (Widya and Martoatmodjo, 1975). This may be because the mineralocorticoid effect of several doses of hydrocortisone might have led to hypervolemia and detrimental effects
Summary
World Health Organization (WHO) has published guidelines for the management of dengue fever This management prevents hemoconcentration during the early phase and fluid overload in the late phase of the illness and halts severe complications such as dengue shock syndrome (DSS) and multiple organ failure. Improved fluid management protocols have resulted in a large decrease in mortality in dengue infection (Wongsa, 2015) This approach does not consider any immune suppressive therapy to prevent immunological damage in dengue hemorrhagic fever (DHF), DSS and other complications in dengue such as carditis, ascites, liver and renal damage, encephalitis and bleeding. A reasonable argument exists regarding corticosteroid use in dengue and this should be investigated This systemic review is conducted on the past researches done on dengue and steroid therapy to identify the strength and weakness of evidence for the use of corticosteroids
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