Intravenous immunoglobulins in the treatment of dengue illness

Dengue infection causes significant morbidity and mortality worldwide. Therapeutic options for severe thrombocytopaenia and shock syndrome, the main causes of mortality, are limited. Careful fluid management is the mainstay of treatment. The immunological basis of the life-threatening manifestations of severe dengue together with the potentially beneficial immunomodulatory effects of intravenous immunoglobulins (IVIG) suggest a possible place for treatment with this expensive therapy. Trials so far have not shown significant benefit in terms of survival or improvement in clinical parameters with IVIG. However, evidence is very limited, and there is clearly a place for well-designed randomized controlled trials investigating the beneficial effects of IVIG in the various life-threatening manifestations of dengue.