From the Guidelines
Dengue fever diagnosis is confirmed through a positive ELISA test, and treatment is primarily supportive, focusing on adequate hydration, fever control with acetaminophen, and monitoring for severe complications, as there is no specific antiviral therapy available 1.
Diagnosis and Treatment Approach
The diagnosis of dengue fever is confirmed through a positive ELISA test, which detects dengue virus antibodies or antigens in the patient's blood. According to the guidelines provided by the MMWR Recommendations and Reports 1, the interpretation of dengue and Zika virus diagnostic testing results is crucial for accurate diagnosis and management.
Key Considerations in Management
- Hydration: Adequate hydration with oral fluids or intravenous fluids if necessary is essential to prevent dehydration and manage the disease.
- Fever Control: Fever control with acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) is recommended, while avoiding NSAIDs like ibuprofen or aspirin due to bleeding risk.
- Monitoring: Patients should rest, monitor their symptoms, and have regular complete blood count tests to watch for decreasing platelet counts, which may indicate progression to severe dengue.
- Warning Signs: Warning signs requiring immediate medical attention include severe abdominal pain, persistent vomiting, bleeding manifestations, lethargy, or liver enlargement.
Disease Progression and Complications
Most patients recover within 1-2 weeks with appropriate supportive care. The critical phase typically occurs around days 3-7 of illness when fever subsides, requiring vigilant monitoring for complications like plasma leakage, hemorrhage, or organ impairment. Dengue's pathophysiology involves an immune response that can lead to increased vascular permeability, explaining why fluid management is crucial to treatment success 1.
Diagnostic Testing
The MMWR Recommendations and Reports provide detailed guidance on the interpretation of dengue and Zika virus diagnostic testing results, including the use of NAATs, IgM antibody testing, and PRNTs 1. Understanding these guidelines is essential for accurate diagnosis and management of dengue fever.
From the Research
Diagnosis of Dengue Fever
- The diagnosis of Dengue fever can be confirmed by testing for dengue virus immunoglobulin M (IgM) using a capture enzyme-linked immunosorbent assay (ELISA) 2.
- The IgM-capture ELISA can be positive as early as disease day 4, and all samples but one were IgM-positive when collected on disease day 5 or later 3.
- The combination of RT-PCR and IgM-capture ELISA can increase the ability to diagnose dengue virus infection, even if only a single serum specimen from the patient is available 3.
- Specific IgM and IgG responses can be determined by enzyme-linked immunosorbent assay (ELISA) to confirm dengue virus infection and differentiate between primary and secondary infections 4.
Treatment of Dengue Fever
- There is no specific treatment for dengue fever, but early detection and management of the disease can help prevent complications.
- Patients with suspected dengue fever should be monitored closely for signs of severe disease, such as bleeding, low platelet count, and blood plasma leakage 5.
- Laboratory findings, such as leucopenia and thrombocytopenia, can also be used to support the diagnosis of dengue fever 5.
Laboratory Findings
- Routine laboratory findings in patients with dengue fever may include leucopenia (90% of cases) and thrombocytopenia (88% of cases) 5.
- The diagnosis of dengue fever can be confirmed by ELISA detection of dengue virus immunoglobulin M antibodies (in 88% of patient's sera) 5.
- The sensitivity and specificity of commercial tests for dengue serology, such as the Dengue Rapid test and Dengue Duo ELISA, have been evaluated and shown to be useful aids in confirming the clinical diagnosis of dengue infection 6.