Corticosteroids in the treatment of dengue illness.

Dengue infection results in significant morbidity and mortality worldwide. Current recommended treatment is largely supportive with careful fluid replacement, with no specific treatment available. Although corticosteroids are not mentioned in the WHO guidelines on the management of dengue, clinicians use corticosteroids empirically based on the presumed immunological basis of the complications of dengue. The evidence base for the benefit or lack of benefit of corticosteroids in dengue is limited; previous studies have been small, with methodological flaws, less stringent randomisation and unclear allocation concealment, and were performed a long time ago. Studies so far have only been in patients with shock syndrome, and the possible effects of corticosteroids on thrombocytopenia and bleeding as well as other complications of dengue are unknown. All previous studies have been in children; the effect of corticosteroid treatment in adults with dengue infection has not been evaluated. The possible beneficial effects of corticosteroids on the various manifestations of dengue infection need evaluation by adequately powered, well designed, randomised controlled trials.