What is Dengue (Dengue fever)?

From the Guidelines

Dengue is a potentially life-threatening viral infection that requires prompt medical attention, and treatment should focus on supportive care to manage symptoms and prevent complications. The disease is transmitted by Aedes species mosquitoes, primarily Aedes aegypti, which are present throughout the tropics and subtropics 1. Infection with dengue can result in an acute illness that includes fever, rash, myalgia, and arthralgia, and certain patients will progress to potentially fatal severe dengue.

Key Considerations

• The incidence of dengue has doubled each decade since 1990, with an estimated 58 million symptomatic infections and 13,000 deaths occurring worldwide in 2013 1.
• Appropriate clinical management can reduce the case-fatality rate among hospitalized patients to <0.5% 1.
• Treatment is primarily supportive, focusing on managing symptoms with acetaminophen for fever and pain, while avoiding NSAIDs like ibuprofen or aspirin due to the increased bleeding risk.
• Staying hydrated by drinking plenty of fluids and getting rest is essential for recovery.

Prevention and Management

• Prevention involves eliminating mosquito breeding sites by removing standing water around homes, using mosquito repellents containing DEET, wearing long-sleeved clothing, and using bed nets.
• Monitoring for warning signs, including severe abdominal pain, persistent vomiting, bleeding gums, rapid breathing, or fatigue, is crucial, as these require immediate medical care.
• There is no specific antiviral treatment for dengue, and recovery typically takes 1-2 weeks 1.
• The virus has four serotypes, and infection with one type provides lifelong immunity to that specific serotype but only temporary protection against others, making subsequent infections potentially more severe due to antibody-dependent enhancement.

From the Research

Overview of Dengue

• Dengue is the commonest vector-borne infection worldwide, often associated with thrombocytopenia 2
• Thrombocytopenia is a hallmark of dengue infection, and bleeding is a dreaded complication of dengue fever 3

Prophylactic Platelet Transfusion

• Prophylactic platelet transfusion is widely used despite the dearth of robust evidence 2
• Studies have shown that prophylactic platelet transfusion was not superior to supportive care in preventing bleeding in adults with dengue and thrombocytopenia 2, 3
• Platelet transfusion in absence of bleeding in adult dengue with platelet count <20,000/mm3 did not reduce bleeding or expedite platelet recovery 3

Adverse Events

• Adverse events that were possibly, probably, or definitely related to transfusion included urticaria, maculopapular rash, pruritus, and chest pain, as well as anaphylaxis, transfusion-related acute lung injury, and fluid overload 2
• There was potential harm by slowing recovery of platelet count to >50,000/mm3 and increasing length of hospitalization 3

Management of Thrombocytopenia

• Discontinuation of antiplatelet therapy did not result in higher composite outcome of major adverse cardiac and cerebrovascular events (MACCE), and all-cause mortality in-hospital and for 1-year post discharge 4
• Platelet transfusions as a treatment for thrombocytopenia have no clear benefits in reduction of severe bleeding or improvement of the platelet count 5, 6
• The effect of platelet transfusion on clot strength in dengue fever with thrombocytopenia-related bleeding was assessed, and no significant improvement in clot strength was observed 5