What is the treatment for Dengue (Dengue Fever)?

Treatment of Dengue Fever

The treatment of dengue fever is primarily supportive care focused on managing symptoms, maintaining adequate hydration, and monitoring for complications, as there is no specific antiviral therapy available for dengue. 1, 2

Clinical Presentation and Diagnosis

• Dengue presents with a spectrum of illness ranging from mild febrile illness to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), with the latter two being rare in travelers 1, 2
• Classic dengue fever is characterized by fever, headache, retro-orbital pain, myalgia, arthralgia (particularly back pain), and rash 1, 2
• Diagnosis is confirmed through nucleic acid amplification tests (NAATs) on serum collected ≤7 days after symptom onset or IgM antibody testing if symptoms have been present for over 5-7 days 1, 2

Treatment Approach

Outpatient Management (Mild Cases)

• Manage symptomatically with close monitoring for signs of deterioration 1
• Maintain adequate oral hydration to prevent dehydration 1
• Use acetaminophen for fever and pain control 1
• Avoid aspirin and NSAIDs due to increased bleeding risk 1
• Monitor complete blood count daily if possible, especially watching for decreasing platelets and increasing hematocrit (signs of plasma leakage) 1

Warning Signs Requiring Closer Monitoring

• Abdominal pain or tenderness 2
• Persistent vomiting 1
• Clinical fluid accumulation 2
• Mucosal bleeding 1
• Lethargy or restlessness 2
• Liver enlargement 1
• Increasing hematocrit with rapidly decreasing platelet count 1

Management of Severe Dengue/Dengue Shock Syndrome

• Intravenous fluid resuscitation is the cornerstone of treatment for patients with significant plasma leakage 1
• For moderate Dengue shock syndrome (pulse pressure >10 and <20 mmHg), crystalloid solutions are recommended as first-line fluid 1
• For severe Dengue shock syndrome (pulse pressure <10 mmHg), colloid solutions may be beneficial, particularly in children 1
• If fluid resuscitation cannot restore tissue perfusion, vasopressors such as dopamine or epinephrine should be considered 1
• Place patients in a semi-recumbent position (head of bed raised to 30-45°) 1
• Monitor for clinical indicators of adequate tissue perfusion including normal capillary refill time, absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, and adequate urine output 1

Special Considerations

Pregnant Women

• Pregnant women with suspected dengue require concurrent dengue and Zika virus testing (serum and urine specimens) as soon as possible within 12 weeks of symptom onset 1
• Both NAAT and IgM antibody testing should be performed, with positive IgM results confirmed by neutralizing antibody tests 1

Children

• Children with dengue may progress to severe disease more rapidly than adults 3
• More vigilant monitoring of vital signs and fluid status is recommended 1, 3
• Careful fluid management is crucial to prevent both under-resuscitation and fluid overload 1

Prevention

• No widely approved antiviral therapy exists for dengue 4, 5
• Dengvaxia® is licensed in 20 countries but recommended only for those with laboratory confirmation of previous dengue virus infection 6, 3
• Vector control remains the primary preventive strategy 4, 5

Common Pitfalls to Avoid

• Using NSAIDs or aspirin for symptom management (increases bleeding risk) 1
• Inadequate fluid resuscitation in patients with signs of shock 1
• Excessive fluid administration leading to pulmonary edema, especially in the recovery phase 1
• Failure to recognize warning signs of severe disease progression 1
• Delayed hospitalization of patients with warning signs or high-risk comorbidities 1, 2