Treatment for Dengue Fever
The treatment for dengue fever is primarily supportive care focused on adequate hydration, acetaminophen/paracetamol for fever and pain management, and careful monitoring for warning signs of severe disease, with avoidance of NSAIDs and aspirin due to increased bleeding risk. 1
Diagnosis
Before initiating treatment, confirm diagnosis through:
- RT-PCR for dengue virus RNA or NS1 antigen detection during acute phase (≤7 days from symptom onset)
- IgM antibody detection or demonstration of fourfold rise/fall in IgG/IgM antibody titers in paired samples during convalescent phase (>5-7 days) 1
- Essential laboratory tests: complete blood count with hematocrit and platelets, liver function tests, and coagulation tests 1
Treatment Algorithm
1. Mild to Moderate Disease (No Warning Signs)
- Oral rehydration with adequate fluid intake
- Acetaminophen/paracetamol for fever and pain (maximum 4g/day for adults)
- Avoid NSAIDs and aspirin due to increased bleeding risk 1
- Daily monitoring of:
- Complete blood count (especially platelets and hematocrit)
- Warning signs
- Urine output
2. Severe Disease or Presence of Warning Signs
- Intravenous fluid resuscitation with crystalloids (5-10 ml/kg/hour) 1
- For shock: 20 mL/kg bolus of crystalloids 1
- Adjust fluid rates based on:
- Clinical status
- Hematocrit trends
- Urine output (target >0.5 ml/kg/hour in adults, >1 ml/kg/hour in children)
- Vital signs
- Semi-recumbent position (head of bed elevated 30-45°) to improve ventilation 1
- Blood transfusion for severe bleeding 2
Warning Signs Requiring Immediate Medical Attention
- Intense abdominal pain
- Persistent vomiting
- Fluid accumulation (ascites, pleural effusion)
- Mucosal bleeding
- Lethargy or irritability
- Hepatomegaly
- Increased hematocrit with rapid decrease in platelet count 1
Monitoring Parameters
- Vital signs
- Hematocrit and platelet counts
- Fluid balance
- Signs of plasma leakage
- Level of consciousness
- Liver and renal function 1
Important Considerations
Potential Complications
- Dengue hemorrhagic fever (bleeding, thrombocytopenia, plasma leakage)
- Dengue shock syndrome (dangerously low blood pressure)
- Metabolic acidosis and disseminated intravascular coagulation in profound shock 3
Pitfalls to Avoid
- Fluid overload: Careful monitoring is essential to prevent fluid overload, especially during recovery phase
- Inappropriate use of NSAIDs/aspirin: Can increase bleeding risk
- Delayed recognition of warning signs: Can lead to progression to severe disease
- Inadequate monitoring: Daily laboratory tests are essential during the critical phase
Prevention
- Vector control through elimination of mosquito breeding sites
- Use of repellents, appropriate clothing, and mosquito nets
- Tetravalent vaccine (Dengvaxia) is 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.