What is the treatment for dengue fever?

Treatment for Dengue Fever

The treatment for dengue fever is primarily supportive care, focusing on adequate hydration, fever management with acetaminophen/paracetamol, and close monitoring for warning signs of severe disease. 1

Assessment and Classification

Dengue is classified into three categories according to WHO:

• Dengue without warning signs
• Dengue with warning signs
• Severe dengue

Warning Signs to Monitor

• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation (pleural effusion, ascites)
• Mucosal bleeding
• Lethargy or restlessness
• Liver enlargement
• Increasing hematocrit with rapid decrease in platelet count 1

Treatment Algorithm

1. Outpatient Management (Mild Disease)

For patients with:

• No warning signs
• No comorbidities
• Ability to maintain oral hydration
• Normal urine output
• No bleeding manifestations

Treatment includes:

• Oral rehydration with adequate fluid intake
• Acetaminophen/paracetamol for fever and pain management
• Avoid NSAIDs (aspirin, ibuprofen) due to bleeding risk
• Daily follow-up until fever resolves 1

2. Inpatient Management (Moderate to Severe Disease)

Hospitalization is recommended for patients with:

• Warning signs
• High-risk factors (pregnancy, advanced age, obesity, diabetes, hypertension, kidney or heart disease)
• Secondary dengue infection

Treatment includes:

• Intravenous fluid therapy with crystalloids at 5-10 ml/kg/hour, adjusted based on clinical response
• Goal: diuresis >0.5 ml/kg/hour in adults, >1 ml/kg/hour in children
• Close monitoring of vital signs, fluid balance, and laboratory parameters
• Regular assessment for signs of capillary leak 1

3. Management of Severe Dengue

For patients with:

• Severe plasma leakage leading to shock
• Severe bleeding
• Severe organ impairment

Treatment includes:

• Aggressive fluid resuscitation
• Blood transfusion if significant bleeding
• Intensive monitoring in ICU setting
• Treatment of complications 1, 2

Laboratory Monitoring

Essential tests include:

• Complete blood count with hematocrit and platelet count
• Liver function tests
• Renal function tests
• Coagulation profile (if bleeding manifestations are present) 1

Special Populations

Children

• More susceptible to fluid overload
• Require closer monitoring and careful fluid management 1

Pregnant Women

• Higher risk of complications
• Require intensive surveillance 1

Older Adults

• Higher risk of severe dengue due to comorbidities
• May require more aggressive management 1

Patients with Secondary Infections

• Higher risk of severe manifestations
• Require closer monitoring for warning signs 1

Discharge Criteria

Patients can be discharged when they have:

• No fever for 48 hours without antipyretics
• Improving clinical status
• Increasing platelet count
• Stable hematocrit
• No respiratory distress
• Good urine output 1

Common Pitfalls to Avoid

1. Using NSAIDs for fever management - can increase bleeding risk
2. Excessive fluid administration - can lead to fluid overload, especially in children and elderly
3. Delayed recognition of warning signs - can lead to progression to severe disease
4. Inadequate monitoring - daily follow-up is essential until fever resolves
5. Premature discharge - patients should meet all discharge criteria before leaving healthcare facility

Prevention

While treating the patient, advise on:

• Preventing mosquito bites during the viremic phase
• Eliminating mosquito breeding sites in the home environment
• Using repellents, appropriate clothing, and mosquito nets 1

With proper management following these guidelines, mortality from dengue can be reduced to less than 0.5% even in hospitalized patients 1.