From the Guidelines
Dengue is a potentially life-threatening viral infection that requires prompt medical attention, and treatment should focus on supportive care with acetaminophen for fever and pain management, while maintaining hydration and monitoring for warning signs 1. The primary mode of transmission is through the bite of an infected Aedes species mosquito, which is prevalent in tropical and subtropical regions.
- Key symptoms include fever, rash, myalgia, and arthralgia, and in severe cases, it can progress to severe dengue, which has a high mortality rate if not managed properly.
- According to the latest evidence, the incidence of dengue has been increasing, with an estimated 58 million symptomatic infections and 13,000 deaths worldwide in 2013 1.
- Treatment should prioritize supportive care, including:
- Acetaminophen (paracetamol) at 500-1000mg every 6 hours for fever and pain management
- Maintaining hydration by drinking plenty of fluids (2-3 liters daily)
- Monitoring for warning signs, such as severe abdominal pain, persistent vomiting, bleeding, or lethargy
- It is essential to note that there is no specific antiviral medication for dengue, and antibiotics are ineffective since it's a viral infection.
- Prevention measures, such as eliminating mosquito breeding sites, using insect repellent containing DEET, wearing long-sleeved clothing, and using bed nets, are crucial in reducing the risk of transmission 1.
From the Research
Dengue Fever Overview
- Dengue fever is a global public health problem, characterized by increased capillary permeability, thrombocytopenia, and coagulopathy 2
- The clinical spectrum of the disease ranges from dengue fever to dengue hemorrhagic fever and dengue shock syndrome 2
Platelet Transfusion in Dengue Patients
- The practice of platelet transfusion has been adapted into the standard clinical practice in management of hospitalized dengue patients, but the exact indications and situations in which platelet have to be transfused may vary greatly 3
- A study found that 71 (20.7%) patients of dengue cases received platelet transfusion, but 26 patients with platelet count >20,000/cumm and with no haemorrhagic manifestations received inappropriate platelet transfusion 3
- Another study found that prophylactic platelet transfusion in adult dengue patients with platelet count <20,000/mm3 without bleeding did not reduce bleeding or expedite platelet recovery, and may even cause potential harm by slowing recovery of platelet count to >50,000/mm3 and increasing length of hospitalization 4
Blood Transfusion in Severe Dengue Infection
- Blood transfusion is recommended mainly in cases of bleeding, but a case series found that blood transfusion can be lifesaving in cases of occult bleeding, acidosis, and severe hepatic damage 5
- The mechanism of this effect needs further explanation, but possibilities include enhanced oxygen delivery to the tissues and hemostasis 5
Effect of Platelet Transfusion on Clot Strength
- A study found that platelet transfusion in dengue patients with bleeding complication improved the absolute platelet count, but did not improve clot strength as assessed by thromboelastography 6
- The study suggested that the majority of patients had ongoing bleeding despite the administration of platelets, highlighting the need for further research on the effectiveness of platelet transfusion in dengue patients 6