Report an error   
Advanced Search

Lack of Efficacy of High-Dose Intravenous Immunoglobulin Treatment of Severe Thrombocytopenia in Patients with Secondary Dengue Virus Infection


Efren M. Dimaano,
Mariko Saito,
Shoko Honda,
Maria T. Alonzo,
Cynthia A. Mapua,
Shingo Inoue,
Atsushi Kumaori,
Ronald R. Matias,
Filipinas F. Natividad,
Kazunori Oishi

Related Institution

Department of Internal Medicine and Virology - Institute of tropical Medicine Nagasaki University

Department of Disaster Prevention System/Faculty of Risk and Crisis Management - Chiba Institute of Science

See More

Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
St. Luke's Journal of Medicine
Publication Date


Because most cases of secondary dengue virus infection are associated with an increased level of plateletassociated IgG, a high dose of intravenous immunoglobulin (IVIG) may have an effect on the development of severe thrombocytopenia in this disease. A randomized, controlled study was conducted with two treatment groups consisting of a treatment (IVIG) group (n  15) and a non-treatment (non-IVIG) group (n  16) to determine whether a high dose of IVIG is effective in hastening the recovery from thrombocytopenia in patients with secondary dengue virus infection. No significant difference was found in the baseline demographic data between the two groups. No adverse effect of IVIG was observed, but no effect in hastening the recovery of platelet counts was found in patients with secondary dengue infections. The lack of efficacy of IVIG suggests that platelet clearance by macrophages through Fc receptors is not a primary mechanism in this disease


1. Halstead, S. B.. "Pathogenesis of dengue: challenges of molecular biology." Science 239, 476-481, 1988
2. La Russa, V. F., Innis, B. L.. "Mechanism of dengue virusinduced bone marrow suppression." Baillieres Clinical Hematology 8, 249-170, 1995
3. Oishi, K. , Saito, M. , Mapua, C. A., Natividad, F. F.. "Dengue illness: clinical features and pathogenesis." Journal of Infection and Chemotherapy 13, 125-133, 2007
4. Gubler, D. J.. "Epidemic dengue/ dengue hemorrhagic fever as a public health, social and economic problems in the 21st century." Trends in Microbiology 10, 100-103, 2002
5. McMillan, R. . "Chronic idiopathic thrombocytopenic purpura" New England Journal of Medicine 304, 1135-1147, 1981
6. Cines, D. B., Blanchette, V. S.. "Immune thrombocytopenic purpura." New England Journal of Medicine 346, 995-1008, 2002
7. Crow, A. R., Song, S. , Siragam, V. , Lazarus, A. H.. "Mechanisms of action of intravenous immunoglobulin in the treatment of immune thrombocytopenia." Pediatric Blood Cancer 47, 710-713, 2006
8. Oishi, K. , Inoue, S. , Cinco, M. T., Dimaano, E. M., Alera, M. T., Alfon, J. A., Abanes, F. , Cruz, D. J., Matias, R. R.. "Correlation between increased platelet-associated IgG and thrombocytopenia in secondary dengue virus infections" Journal of Medical Virology 71, 259-264, 2003
9. Saito, M. , Oishi, K. , Inoue, S. , Dimaano, E. M., Alera, M.T. P., Robles, M. P., Estrella, J. R., Kumatori, A. , Moji, K. , Alonzo, B.M. T., Buerano, C. C., Matias, R. R., Morita, K. , Natividad, F. F., Nagatake, T. . "Association of increased platelet-associated immunoglobulins with thrombocytopenia and the severity of disease in secondary dengue virus infections." Clinical & Experimental Immunology 138, 299-303, 2004
10. Ascher, D. P., Laws, H. F., Hayes, C. G.. "The use of intravenous gammaglobulin in dengue fever, a case report." Southeast Asian Journal of Tropical Medicine and Public Health 20, 549-554, 1989
11. World, Health Organization. Dengue Haemorrhagic Fever. Diagnosis, Treatment, Prevention and Control. 2nd Ed. Geneva: World Health Organization, 1997.
12. Berlioz-Arthaud, A. , Marfel, M. , Durand, A. M., Ogawa, T. . "Evaluation of a new anti-dengue virus IgM particle agglutination kit in the context of the Pacific islands" Bulletin of the World Health Organization 29, 70-78, 2005
13. Bundo, K. , Igarashi, A. . "Antibody-capture ELISA for detection of immunoglobulin M antibodies in sera from Japanese encephalitis and dengue hemorrhagic fever patients." Journal of Virological Methods 11, 15-22, 1985
14. Morita, K. , Tanaka, M. , Igarashi, A. . "Rapid identification of dengue virus serotypes by using polymerase chain reaction." Journal of Clinical Microbiology 29, 2107-2110, 1991
15. Clarke, D. H., Cassals, J. . "Techniques for hemagglutination and hemagglutination-inhibition with arthropod-borne viruses" American Journal of Tropical Medicine and Hygiene 7, 561-573, 1958
16. Kurlander, R. J., Roose, W. F.. "Efficacy of a 2-day schedule for g intravenous immunoglobulin (IVIg) in treating adults with ITP." Blood 291, 484, 1986
17. Bierling, P. , Godeau, B. . "Intravenous immunoglobulin for autoimmune thrombocytopenic purpura." Human Immunology 66, 387-394, 2005
18. Avirutnan, P. , Punyanadee, N. , Noisaran, S. , Komoltri, C. , Thiemeca, S. , Auethavornanan, K. , Jairungsri, A. , Kanlaya, R. , Tangtawornchailul, N. , Puttikhunt, C. , Pattnakisakul, S. , Yenchitsomnus, P. , Monkolsapaya, J. , Kasinrerk, W. , Sittisombut, N. , Husmann, M. , Blettner, M. , Vasanawathana, S. , Bhakdi, S. , Mlasit, P. . "Vascular leakage in severe dengue virus infections: a potential role for the nonstructural viral protein NS1 and complement." Journal of Infectious Diseases 193, 1078-1088, 2006

Physical Location

LocationLocation CodeAvailable FormatAvailability
RITM Fulltext Print Format

©2022 HERDIN PLUS. All rights reserved. | Contact Us | Keep up to date