From the Guidelines
The management of Dengue Hemorrhagic Syndrome Virus (DHSV) should focus on early recognition, prompt initiation of supportive care, and careful fluid management to prevent complications and improve outcomes. According to the case definitions for infectious conditions under public health surveillance by the Centers for Disease Control and Prevention 1, Dengue hemorrhagic fever is defined as an acute febrile illness with minor or major bleeding phenomena, thrombocytopenia, and evidence of plasma leakage.
Key Components of Management
- Early recognition and prompt initiation of intravenous fluid therapy are essential to prevent shock and organ failure
- Careful fluid management with isotonic crystalloid solutions like normal saline or Ringer's lactate, with monitoring of vital signs and laboratory parameters
- Antipyretics should be limited to acetaminophen (paracetamol) to avoid bleeding risk
- Blood products may be necessary for severe bleeding, with platelet transfusions considered when counts fall below 10,000/mm³ or with significant bleeding
Monitoring and Supportive Care
- Vital signs should be monitored hourly during the critical phase, with particular attention to blood pressure, pulse, respiratory rate, temperature, and urine output
- Laboratory monitoring should include complete blood count, hematocrit, platelet count, liver function tests, and coagulation studies every 6-12 hours during the critical phase
- Severe cases may require intensive care monitoring, with careful attention to signs of shock, respiratory distress, or organ failure
Critical Period and Fluid Management
- The critical period typically occurs during the transition from febrile to afebrile phase (days 3-7 of illness), when plasma leakage can lead to shock if not properly managed
- Overzealous fluid administration should be avoided as it can lead to pulmonary edema, particularly during the recovery phase when fluid reabsorption occurs, as noted in the guidelines for managing dengue hemorrhagic fever 1.
From the Research
Clinical Practice Guidelines for Dengue Hemorrhagic Syndrome Virus (DHSV) Management
- The management of DHSV involves symptomatic treatment, with a focus on controlling fever and managing hemorrhagic manifestations 2.
- Nonsteroidal anti-inflammatory drugs should be avoided in patients with DHSV, as they can promote bleeding and acidosis 2, 3.
- Intravenous fluid infusion is a crucial component of DHSV management, with repeated monitoring of vital parameters and packed cell volume (PCV) 2.
- Patients with DHSV may require blood component therapy, including platelet concentrate, packed red cells, and fresh frozen plasma, particularly in cases of active bleeding or circulatory failure 4.
- The diagnosis of DHSV is based on typical clinical findings, including fever, hemorrhagic manifestations, thrombocytopenia, and hemoconcentration 2, 5.
- Laboratory findings in DHSV may include rising hematocrit, thrombocytopenia, and transformed lymphocytes on peripheral smear, as well as increased transaminases, hyponatremia, and transient increases in blood urea nitrogen and creatinine 2, 5.
Special Considerations
- Patients with underlying comorbidities, such as lupus nephritis, may pose diagnostic and therapeutic challenges in the management of DHSV 6.
- In such cases, a restrictive fluid approach may be necessary, with close monitoring for hemodynamic instability and adjustment of fluid quotas as needed 6.
- The use of steroids and anticoagulation in patients with lupus nephritis and DHSV requires careful consideration of the risks and benefits 6.
Treatment Approaches
- Basic supportive therapy, including sufficient hydration and fluid therapy, is a standard of care for DHSV 3.
- Effective antiviral drugs for DHSV are not currently available, and treatment is focused on managing symptoms and preventing complications 3.
- Aspirin and other non-steroidal anti-inflammatory drugs should be avoided in patients with DHSV, as they can promote bleeding and acidosis 3.