Treatment of Dengue
The treatment for dengue is primarily supportive management with careful monitoring of fluid status, especially in patients with dengue shock syndrome who require an initial fluid bolus of 20 mL/kg with subsequent reassessment. 1
General Management Principles
- Symptomatic management is the cornerstone of dengue treatment as there is no specific antiviral therapy currently approved 1
- Daily complete blood count monitoring is essential, particularly to track platelet counts and hematocrit levels in patients at risk of progression to shock 1
- Avoid aspirin and other non-steroidal anti-inflammatory drugs due to increased bleeding risk 1
Fluid Management
For Dengue Shock Syndrome:
- Administer an initial fluid bolus of 20 mL/kg with careful patient reassessment afterward 1
- In severe dengue shock syndrome (pulse pressure <10 mmHg), colloid solutions may be beneficial when available 1
- In moderate dengue shock syndrome (pulse pressure >10 and <20 mmHg), crystalloid solutions are equally effective and should be first-line 1
For Dengue Without Shock:
- Oral rehydration is appropriate for patients without signs of shock 1
- Avoid routine use of bolus intravenous fluids in patients with "severe febrile illness" who are not in shock 1
Monitoring Parameters
Watch for clinical indicators of adequate tissue perfusion 1:
- Normal capillary refill time
- Absence of skin mottling
- Warm and dry extremities
- Well-felt peripheral pulses
- Return to baseline mental status
- Adequate urine output
Monitor for warning signs of progression to severe disease 1:
- High hematocrit with rapidly falling platelet count
- Severe abdominal pain
- Persistent vomiting
- Lethargy or restlessness
- Mucosal bleeding
Management of Complications
- For patients with persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1
- Avoid overhydration, which can lead to pulmonary edema, particularly during the recovery phase 1
- Blood transfusion may be necessary in cases of significant bleeding 1
Investigational Therapies
- Corticosteroids have shown insufficient evidence of benefit in both early dengue and dengue-related shock 2
- Pentoxifylline has been studied for its anti-inflammatory properties in dengue hemorrhagic fever, but remains investigational 3
- Multiple antiviral therapies are under investigation but none are currently recommended for routine clinical use 4, 5
Common Pitfalls to Avoid
- Administering excessive fluid boluses in patients without shock can lead to fluid overload and respiratory complications 1
- Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
- Using aspirin or NSAIDs, which can worsen bleeding tendencies 1
- Delaying fluid resuscitation in patients with dengue shock syndrome 1
- Inadequate monitoring of patients during the critical phase of illness 1, 6