What is the treatment for dengue?

Treatment of Dengue

The treatment of dengue is primarily supportive care, focusing on adequate fluid management, fever control with acetaminophen, and close monitoring for warning signs of severe disease, as there is no specific antiviral therapy recommended for routine use. 1

Diagnosis and Initial Assessment

• Consider dengue in patients presenting with:

  • Fever plus one or more symptoms: nausea/vomiting, rash, headache, retro-orbital pain, myalgia/arthralgia, positive tourniquet test, leukopenia, or warning signs of severe disease 1
  • Laboratory findings supporting diagnosis: thrombocytopenia, leukopenia, elevated hematocrit, and elevated liver enzymes 1

• Diagnostic testing options:

  • Acute phase: RT-PCR for dengue virus RNA or NS1 antigen detection
  • Convalescent phase: IgM antibody detection or demonstration of fourfold rise/fall in IgG or IgM antibody titers in paired samples 1

Treatment Protocol

Mild to Moderate Disease (Dengue Fever)

1. Fever and Pain Management:

   • Acetaminophen 650-1000 mg every 4-6 hours (maximum 4g/day) 1
   • Strictly avoid aspirin and NSAIDs due to increased bleeding risk 1

2. Hydration:

   • Encourage oral fluid intake
   • Monitor for signs of dehydration
   • Educate patients about warning signs requiring immediate medical attention 1

Severe Disease (Dengue Hemorrhagic Fever/Dengue Shock Syndrome)

1. Initial Resuscitation:

   • Crystalloid fluid bolus of 20 ml/kg as rapidly as possible
   • May need to repeat 2-3 times in profound shock 1

2. Ongoing Fluid Management:

   • Fluid administration rate of 5-10 ml/kg/hour
   • Adjust according to clinical response
   • Monitor vital signs every 15-30 minutes during rapid fluid administration 1

3. Laboratory Monitoring:

   • Serial complete blood counts
   • Hematocrit levels
   • Platelet counts
   • Liver function tests 1

Special Populations

Children

• Require closer monitoring
• More susceptible to fluid overload
• Initial fluid bolus of 20 mL/kg for dengue shock syndrome
• Regular reassessment to detect deterioration or fluid overload early 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

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

Prevention and Follow-up

• Patient education on protecting themselves from further mosquito exposure 1
• Follow-up evaluation after 2-4 weeks to assess response to therapy 1
• Educate patients on red flags requiring urgent medical attention:
  • Worsening headaches
  • Focal neurological signs
  • Altered mental status 1

Important Considerations

• There is currently no specific antiviral therapy for dengue 1, 2
• No commercially available vaccine is widely recommended for all populations 2, 3
• The Dengvaxia vaccine has been recommended by ACIP for children aged 9-16 years living in endemic areas with laboratory confirmation of previous dengue infection 3
• Vector control remains a critical component of dengue prevention 2, 4

Common Pitfalls to Avoid

• Using NSAIDs or aspirin for fever control (increases bleeding risk)
• Inadequate fluid resuscitation in severe cases
• Failure to recognize warning signs of progression to severe disease
• Overhydration, especially in children and older adults
• Discharging patients prematurely before stabilization of clinical parameters