What is the treatment for dengue?

Treatment for Dengue Fever

The treatment for dengue fever is primarily supportive care with careful fluid management, as there is no specific antiviral therapy available. 1

Clinical Assessment and Diagnosis

• Dengue presents with fever, headache, myalgia, rash, and leukopenia
• Diagnosis is confirmed through:
  • PCR testing (acute phase)
  • IgM capture ELISA
  • Convalescent IgG at 3 weeks 1
• Distinguish from other febrile illnesses by:
  • More severe thrombocytopenia
  • Elevated liver transaminases
  • Positive dengue-specific serological tests 1

Treatment Approach

Fluid Management (Critical Component)

• Initial resuscitation for patients with shock:
  • Crystalloid fluid bolus of 20 ml/kg administered rapidly
  • May need to be repeated 2-3 times in profound shock 1
• Maintenance fluid therapy:
  • Rate: 5-10 ml/kg/hour, adjusted based on clinical response
  • Normal saline is preferred over lactated Ringer's solution
  • Monitor for fluid overload (dyspnea, enlarging liver, gallop rhythm, pulmonary edema) 1

Special Considerations

• Patients with chronic kidney disease: Administer lower fluid volumes
• Electrolyte management: Add 20-30 mEq/L potassium (2/3 KCl and 1/3 KPO4) to maintenance fluids once renal function is assured 1
• Children: More susceptible to fluid overload; require closer monitoring 1
• Pregnant women: Higher risk of complications; require more intensive surveillance 1
• Older adults: Higher risk of severe dengue; may need more aggressive management 1

Monitoring Parameters

• Vital signs every 15-30 minutes during rapid fluid administration
• Monitor for warning signs of 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

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 Caveats

1. No specific antiviral therapy: Unlike many other viral infections, dengue has no approved specific antiviral treatment 2, 3

2. Avoid NSAIDs and aspirin: These medications may increase bleeding risk and should be avoided; acetaminophen is preferred for fever and pain management

3. Critical phase monitoring: The period of defervescence (when fever subsides, typically days 3-7) is when plasma leakage and hemorrhagic complications are most likely to occur and requires vigilant monitoring 3, 4

4. Prevent secondary infection: Dengue patients should be protected from mosquito bites to prevent transmission to others

5. Follow-up evaluation: Recommended 2-4 weeks after treatment to assess recovery 1

Prevention

• Vector control is currently the only effective method for preventing dengue spread 2, 5
• The WHO recommends implementing early warning systems for outbreaks and enhanced vector surveillance 1
• No commercially available vaccine is widely approved for general use 2, 5