Effect of high-dose dexamethasone on the outcome of acute encephalitis due to Japanese encephalitis virus.
Death due to Japanese encephalitis usually occurs in the first 5 days of hospitalization as a result of deepening coma with respiratory arrest. Death may result from edema-induced increases in intracranial pressure that might be reduced by the administration of steroids. Sixty-five patients presenting in Thailand to four hospitals with a diagnosis of acute Japanese encephalitis were randomized in a double-masked fashion and stratified by initial mental status into a placebo group (saline) or a treatment group (dexamethasone 0.6 mg/kg intravenously as a loading dose followed by 0.2 mg/kg every 6 h for 5 days). Fifty-five of the 65 had confirmed Japanese encephalitis as demonstrated by detection of virus or by Japanese encephalitis virus-specific IgM antibody. Important outcome measures included mortality (24%, treatment group; 27%, control group), days to alert mental status (3.9 vs. 6.2), and neurologic status 3 months after discharge (45% abnormal in each group). No statistically significant benefit of high-dose dexamethasone could be detected.
Hoke
C H
CH
Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
Vaughn
D W
DW
Nisalak
A
A
Intralawan
P
P
Poolsuppasit
S
S
Jongsawas
V
V
Titsyakorn
U
U
Johnson
R T
RT
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D004672:Encephalitis, Japanese / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D016896:Treatment Outcome
D003907:Dexamethasone; D005947:Glucose