What is the treatment for Dengue (Dengue hemorrhagic fever)?

From the Guidelines

The primary treatment for Dengue hemorrhagic fever involves fluid resuscitation with crystalloids and/or colloids, with a preference for crystalloids in most cases, and the use of dopamine or epinephrine in patients with persistent tissue hypoperfusion despite fluid resuscitation 1. When managing Dengue hemorrhagic fever, it's crucial to prioritize fluid resuscitation.

• Crystalloids are the first-line choice for fluid resuscitation due to their lower cost and fewer side effects compared to colloids 1.
• Colloids may be considered in children with severe Dengue shock syndrome, characterized by a pulse pressure of less than 10 mmHg 1.
• In cases where fluid resuscitation is insufficient to restore tissue perfusion, the use of dopamine or epinephrine should be considered, with dopamine being a potential first choice due to its balanced effect on heart rate and blood pressure 1.
• The administration of intravenous hydrocortisone or prednisolone may be considered in adult patients requiring escalating doses of epinephrine or dopamine, and potentially in children with severe shock, although the evidence for this is less strong 1.
• Monitoring of arterial blood pressure and heart rate is essential in patients receiving dopamine or epinephrine, with measurements taken frequently, ideally every 5-15 minutes 1.
• It's also important to note that there is no specific antiviral treatment for Dengue fever, and management focuses on preventing complications through careful monitoring and supportive care until the viral infection resolves naturally.
• Laboratory monitoring of platelet count and hematocrit is crucial during the critical phase of the illness to promptly identify any severe complications.
• Maintaining adequate fluid intake and monitoring for warning signs such as severe abdominal pain, persistent vomiting, bleeding, or lethargy are also critical components of care.

From the Research

Treatment Overview

• The treatment for Dengue hemorrhagic fever is primarily symptomatic, as no treatment directed against the cause of the disease is available 2, 3, 4.
• The key measures in treating Dengue fever include adequate volume replacement and, in patients with hemorrhage, the transfusion of blood products 2.
• Supportive care with fluids is the main therapeutic approach for managing Dengue fever 3, 4.

Role of Antiviral Drugs and Corticosteroids

• The role of antiviral drugs in the treatment of Dengue fever has been limited, but is currently widely studied 4.
• Corticosteroids are not mentioned in the WHO guidelines on the management of Dengue, and their use is based on empirical evidence 5.
• The evidence base for the benefit or lack of benefit of corticosteroids in Dengue is limited, and further studies are needed to evaluate their effects 5.

Emerging Treatment Options and Vaccines

• There have been recent advances in the development of promising drugs for the treatment of Dengue, including direct antivirals and host-targeted drugs 6.
• New vaccine candidates are being evaluated for their safety and efficacy in preventing Dengue disease 6.
• One Dengue vaccine is approved for Dengue-immune individuals, but there is still a need for therapeutics and vaccines that can reduce Dengue morbidities and lower the infection burden 6.