What is the treatment for dengue fever?

Treatment of Dengue Fever

The cornerstone of dengue fever management is supportive care with judicious fluid administration, with an initial crystalloid fluid bolus of 20 mL/kg recommended for patients with dengue shock syndrome, followed by close monitoring and adjustment of fluid rates according to clinical response. 1

Fluid Management

Initial Assessment and Fluid Resuscitation

• For patients with dengue shock syndrome:
  • Administer initial crystalloid fluid bolus of 20 mL/kg as rapidly as possible 1
  • May need to repeat 2-3 times in profound shock 1
  • Continue with fluid administration rate of 5-10 mL/kg/hour, adjusted according to clinical response 1

Monitoring During Fluid Administration

• Monitor vital signs every 15-30 minutes during rapid fluid administration 1
• Document accurate weight, baseline vital signs including pulse pressure
• Check baseline hematocrit, measure urine output, assess respiratory status 1
• Watch for signs of fluid overload:
  • Increasing respiratory rate with normal/falling hematocrit
  • New crackles on lung examination
  • Rising JVP
  • New onset hepatomegaly
  • Peripheral edema 1

Warning Signs Requiring Closer Monitoring

Monitor for warning signs that indicate progression to severe dengue:

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

Special Populations

Children

• More susceptible to fluid overload
• Require closer monitoring
• Initial fluid bolus of 20 mL/kg for children with dengue shock syndrome 2, 1
• Regular reassessment is critical to detect deterioration early 2, 1

Pregnant Women

• Higher risk of complications
• Require more intensive surveillance 1

Older Adults

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

Medication Considerations

• Avoid aspirin and NSAIDs due to increased risk of bleeding complications 1, 3
• Use acetaminophen for fever and pain relief 1
• No specific antiviral treatment is currently recommended for routine use 4, 5
• No recommendation for thymosin alpha 1 due to lack of specific evidence 1

Laboratory Diagnosis

Diagnosis can be confirmed by:

• RT-PCR for dengue virus RNA in serum (up to day 5 of illness) 1, 4
• NS1 antigen detection during acute phase 1
• IgM antibody detection or demonstration of fourfold rise/fall in IgG or IgM antibody titers in paired samples during convalescent phase 1

Discharge Criteria

Patients can be discharged when:

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

Prevention of Transmission

• Protect patients from further mosquito exposure to prevent transmission 1
• Implement mosquito control measures 3

Clinical Pearls and Pitfalls

• Dengue typically follows a triphasic course: febrile phase, critical phase, and recovery phase 4
• The critical phase (days 3-7 of illness) is when plasma leakage and most complications occur
• Avoid prophylactic platelet transfusion, which is not recommended 5
• Recognize that secondary infection with a different dengue serotype increases risk of severe disease 1
• Consider secondary hemophagocytic lymphohistiocytosis in severe cases, which may require specific management with steroids or IVIG 5

While dengue is typically self-limiting in over 90% of cases 4, early recognition of warning signs and appropriate fluid management are crucial to prevent progression to severe disease and reduce mortality.