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      Dengue and Thrombotic Thrombocytopenic Purpura

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          Abstract

          Sir, The publication on “Dengue and Thrombotic Thrombocytopenic Purpura (TTP) is very interesting.”[1] Gavali et al. reported a case and raised a conclusion that “timely diagnosis and starting appropriate treatment immediately are key factors for successful outcome.”[1] It is no doubt that TTP can be a complication of dengue. TTP in dengue is sporadically reported and it can be easily missed due to lack of complete diagnostic investigation.[2] Deepanjali et al. noted that “jaundice with a disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.”[3] Nevertheless, this important observation was not seen in the present case report by Gavali et al.[1] In the present case, it is no doubt that there was a co-occurrence of dengue and TTP. However, there are other important concerns. First, there are also other arbovirus infections that might induce TTP such as chikungunya that might be a forgotten concurrent infection.[4] Second, there are also other possible common underlying causes of the reported clinical features that are not ruled out. The important examples are Vitamin B12 and Vitamin D deficiencies.[5] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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          Dengue fever: diagnosis and treatment.

          Dengue fever is a common tropical infection. This acute febrile illness can be a deadly infection in cases of severe manifestation, causing dengue hemorrhagic shock. In this brief article, I will summarize and discuss the diagnosis and treatment of this disease. For diagnosis of dengue, most tropical doctors make use of presumptive diagnosis; however, the definite diagnosis should be based on immunodiagnosis or viral study. Focusing on treatment, symptomatic and supportive treatment is the main therapeutic approach. The role of antiviral drugs in the treatment of dengue fever has been limited, but is currently widely studied.
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            Fatal case of chikungunya and concomitant thrombotic thrombocytopenic purpura in French Guiana during air flight medical evacuation.

            Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy associated to severe ADAMTS13 deficiency. It has been linked to various viral infections. Among arboviruses, only Crimean-Congo haemorrhagic fever and dengue fever have been linked to this severe disease. We report the first documented case of TTP concomitant to Chikungunya virus infection.
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              Thrombotic Thrombocytopenic Purpura in a Case of Dengue Fever: A Rare Presentation

              Here, we present an unusual occurrence of thrombotic thrombocytopenic purpura (TTP) in a case of dengue fever. Both the conditions are fatal and can result in significant mortality and morbidity if left untreated. In this case, as soon as, we diagnosed the patient as having TTP, we treated her with plasma exchange therapy, steroids, and monoclonal antibodies such as rituximab. The patient responded very well to the treatment and completely recovered from neurological symptoms and laboratory parameters also normalized. Hence, timely diagnosis and starting appropriate treatment immediately are key factors for successful outcome.
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                Author and article information

                Journal
                Indian J Crit Care Med
                Indian J Crit Care Med
                IJCCM
                Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
                Medknow Publications & Media Pvt Ltd (India )
                0972-5229
                1998-359X
                August 2017
                : 21
                : 8
                : 540-541
                Affiliations
                [1 ]Public Health Curriculum, Surindra Rajabhat University, Surin, Thailand
                [2 ]Department of Tropical Medicine, Hainan Medical University, Hainan Sheng, China
                [3 ]Dr. DY Patil University, Pune, Maharashtra, India
                [4 ]Department of Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
                [5 ]Department of Biological Science, Joseph Ayo Babalola University, Ilara-Mokin, Nigeria
                Author notes
                Address for correspondence: Prof. Viroj Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand. E-mail: wviroj@ 123456yahoo.com
                Article
                IJCCM-21-540
                10.4103/ijccm.IJCCM_217_17
                5588495
                4eecfb7c-8c10-4a56-81d9-ad1379853bc2
                Copyright: © 2017 Indian Journal of Critical Care Medicine

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Letters to the Editor

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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