From the Guidelines
The primary treatment for dengue fever is supportive care, focusing on fluid resuscitation and management of shock, as outlined in the 2012 recommendations for sepsis management in resource-limited settings 1. The goal of treatment is to prevent complications and reduce morbidity and mortality.
- For patients with severe Dengue shock syndrome, fluid resuscitation with crystalloids and/or colloids is recommended, with colloids potentially offering benefits in children 1.
- In cases of moderate Dengue shock syndrome, crystalloids are the first-line fluid, as they lead to similar outcomes as colloids and are more suitable in resource-limited settings due to lower costs and fewer side effects 1.
- For patients with persistent tissue hypoperfusion despite fluid resuscitation, the use of dopamine or epinephrine (adrenaline) should be considered, with norepinephrine (noradrenaline) preferred over epinephrine when available 1.
- It is essential to frequently monitor arterial blood pressure and heart rate in patients requiring dopamine or epinephrine, with non-invasive blood pressure measurements taken at 5-15 minute intervals 1.
- In adult patients requiring escalating dosages of epinephrine or dopamine, administering intravenous hydrocortisone (up to 300 mg/day) or prednisolone (up to 75 mg/day) may be beneficial, with equivalent doses considered for children with severe shock 1.
From the Research
Treatment for Dengue Fever
The treatment for dengue fever is primarily symptomatic, as there is no specific treatment directed against the cause of the disease 2. The key measures include:
- Adequate volume replacement
- Transfusion of blood products in patients with hemorrhage
Blood Transfusion in Dengue Fever
Blood transfusion is recommended mainly in cases of bleeding 3. The use of blood products, such as platelet concentrates, packed red cells, and fresh frozen plasma, may be necessary in patients with dengue hemorrhagic fever (DHF) 4. The decision to transfuse blood products should be based on the patient's clinical condition, such as active bleeding, rapid drop in hematocrit, and circulatory failure 4.
Platelet Transfusion in Dengue Fever
Platelet transfusion is often used in the management of dengue patients with thrombocytopenia 5, 6. However, the exact indications and situations in which platelet transfusion is necessary may vary greatly 5. It is essential to develop specific guidelines for transfusion of blood components and to ensure optimal utilization of blood components 5, 6.
Management of Severe Dengue Infection
In severe cases of dengue infection, blood transfusion may be lifesaving, especially in cases of occult bleeding, acidosis, and severe hepatic damage 3. The management of severe dengue infection requires close monitoring of the patient's clinical condition and timely intervention with blood transfusion and other supportive measures 3.