What is the treatment for dengue?

Treatment of Dengue

The primary treatment for dengue is supportive care focused on adequate hydration, acetaminophen/paracetamol for fever and pain management, and careful monitoring of vital signs, hematocrit, platelets, and fluid balance. 1

Clinical Classification and Assessment

Dengue presents as an acute febrile illness with:

• High fever
• Severe headache
• Retro-orbital pain
• Muscle and joint pain
• Rash
• Possible progression to severe forms (dengue hemorrhagic fever and dengue shock syndrome)

Warning Signs Requiring Close Monitoring

• Intense abdominal pain
• Persistent vomiting
• Fluid accumulation
• Mucosal bleeding
• Lethargy or irritability
• Hepatomegaly
• Increased hematocrit with rapid decrease in platelet count 1

Diagnostic Testing

• Acute phase (≤7 days from symptom onset):

  • RT-PCR for dengue virus RNA in serum
  • NS1 antigen detection

• Convalescent phase (>5-7 days):

  • IgM antibody detection
  • Demonstration of fourfold rise/fall in IgG or IgM antibody titers in paired samples 1

• Essential laboratory tests:

  • Complete blood count with hematocrit and platelets
  • Liver function tests
  • Coagulation tests 1

Treatment Algorithm

1. Uncomplicated Dengue

• Ensure adequate oral fluid intake
• Acetaminophen/paracetamol for fever and pain (avoid NSAIDs and aspirin due to bleeding risk)
• Rest and symptomatic relief
• Monitor for warning signs 1

2. Dengue with Warning Signs

• Initiate fluid therapy with crystalloids (5-10 mL/kg/hour)
• Monitor vital signs, hematocrit, platelets, and fluid balance every 1-2 hours
• Adjust fluid rates based on clinical response
• Goal: achieve diuresis >0.5 mL/kg/hour in adults and >1 mL/kg/hour in children 1

3. Severe Dengue/Dengue Shock Syndrome

• Initial fluid resuscitation: 20 mL/kg bolus of crystalloids for children with shock 2, 1
• Place patient in semi-recumbent position (head of bed elevated 30-45°) 1
• If shock persists despite adequate fluid replacement, consider vasopressors:
  • Dopamine or epinephrine
  • Norepinephrine for excessive peripheral vasodilation 1
• Manage significant bleeding with transfusion of blood products as needed (no prophylactic platelet transfusion) 1

Fluid Management Principles

• Crystalloids are the first-line fluid choice 1
• Careful monitoring to avoid fluid overload
• Adjust fluid rates based on:
  • Clinical status
  • Hematocrit trends
  • Urine output
  • Vital signs 1

Special Considerations

Pediatric Patients

• Initial fluid bolus of 20 mL/kg for children with dengue shock syndrome (weak recommendation, low-quality evidence) 2
• Subsequent reassessment is critical 2
• Target urine output >1 mL/kg/hour 1

Pregnancy

• For symptomatic pregnant women with possible dengue exposure:
  • Collect serum and urine specimens as soon as possible within 12 weeks of symptom onset
  • Perform concurrent dengue and Zika virus NAATs and IgM antibody testing 2

Monitoring Parameters

• Vital signs (pulse, blood pressure, respiratory rate)
• Hematocrit and platelet counts (monitor for rapid changes)
• Fluid balance (intake/output)
• Signs of plasma leakage (edema, ascites, pleural effusion)
• Level of consciousness
• Liver and renal function 1

Common Pitfalls to Avoid

1. Using NSAIDs or aspirin - increases bleeding risk
2. Excessive fluid administration - can lead to pulmonary edema and respiratory distress
3. Inadequate monitoring - may miss progression to severe disease
4. Prophylactic platelet transfusion - not recommended based on platelet count alone
5. Delayed recognition of warning signs - can lead to increased morbidity and mortality

Prevention

• Vector control through elimination of mosquito breeding sites
• Use of repellents, appropriate clothing, and mosquito nets
• Tetravalent vaccine (Dengvaxia) available in some countries but recommended only for those with confirmed previous dengue infection 1

With proper supportive care and monitoring, mortality from dengue can be reduced to less than 0.5% even in hospitalized patients 1.