What is the treatment for dengue?

Treatment for Dengue

The treatment for dengue is primarily supportive care, focusing on oral hydration, acetaminophen/paracetamol for fever and pain, daily follow-up until fever resolves, and strict avoidance of NSAIDs and aspirin due to bleeding risk. 1

Initial Management and Outpatient Care

For uncomplicated dengue cases, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend:

• Oral hydration: Encourage adequate fluid intake
• Acetaminophen/paracetamol: For fever and pain management
• Avoid NSAIDs and aspirin: Due to increased risk of bleeding
• Daily monitoring: Until fever resolves
• Patient education: About warning signs requiring immediate medical attention 1

Patients can be managed as outpatients if they:

• Have no comorbidities
• Can maintain oral hydration
• Have normal urine output
• Show no bleeding manifestations 1

Warning Signs Requiring Hospitalization

Patients should be monitored closely for progression to severe disease if any of these warning signs develop:

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

Hospital Management

For patients requiring hospitalization:

1. Fluid therapy:

   • Start with crystalloids at 5-10 ml/kg/hour
   • Adjust according to clinical response
   • Monitor for fluid overload 1

2. Laboratory monitoring:

   • Complete blood count (focusing on platelet count and hematocrit)
   • Liver function tests
   • Coagulation studies if bleeding is present 1

3. Vital sign monitoring:

   • Blood pressure
   • Heart rate
   • Respiratory rate
   • Urine output 1

High-Risk Populations

More intensive monitoring and potentially adjusted management is recommended for:

• Pregnant women
• Older adults
• Children
• Patients with comorbidities (diabetes, hypertension, kidney or heart disease, hemoglobinopathies) 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

Important Clinical Considerations

Diagnostic Approach

During the acute phase (0-7 days), diagnosis can be made using:

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

During the convalescent phase:

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

Laboratory Findings Supporting Diagnosis

• Thrombocytopenia (platelet count <100,000/mm³)
• Leukopenia
• Elevated hematocrit (indicating hemoconcentration)
• Elevated liver enzymes 1

Prevention Measures

While treating the patient, also advise on prevention:

• Prevent mosquito bites during the viremic phase
• Eliminate mosquito breeding sites in the home environment
• Use repellents, appropriate clothing, and mosquito nets 1

Limitations of Current Treatment

It's important to note that there is no specific antiviral treatment for dengue infections 2. Management is entirely supportive, focusing on fluid replacement and symptom management. With proper supportive care, mortality from dengue can be reduced to less than 0.5% even in hospitalized patients 1.

Common Pitfalls to Avoid

1. Using NSAIDs or aspirin: These medications increase bleeding risk and should be strictly avoided
2. Inadequate fluid management: Both dehydration and fluid overload can be dangerous
3. Missing warning signs: Delayed recognition of progression to severe dengue can be fatal
4. Inappropriate discharge: Patients should meet all discharge criteria before leaving the hospital
5. Neglecting high-risk groups: Pregnant women, children, elderly, and those with comorbidities need closer monitoring