What is the treatment for Dengue (Dengue Fever)?

Treatment of Dengue Fever

The cornerstone of dengue treatment is symptomatic management with careful fluid balance, as there is no specific antiviral therapy currently approved for dengue. 1

Clinical Classification and Management Approach

• Dengue illness presents on a spectrum from mild febrile illness to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), with severe forms being rare in travelers 2
• The disease typically follows a triphasic course: febrile phase, critical phase, and recovery phase 3

Initial Assessment and Diagnosis

• Perform nucleic acid amplification tests (NAATs) on serum collected ≤7 days after symptom onset 2
• For specimens collected >7 days after symptom onset or NAAT-negative samples, perform IgM antibody testing 2
• Monitor complete blood count daily, particularly tracking platelet counts and hematocrit levels 1
• Watch for warning signs of progression to severe disease: high hematocrit with rapidly falling platelet count, severe abdominal pain, persistent vomiting, lethargy, and mucosal bleeding 1

Treatment Guidelines

Fluid Management

• For patients without signs of shock:

  • Provide oral rehydration therapy and encourage increased fluid intake 1
  • Avoid routine use of bolus intravenous fluids in patients with severe febrile illness who are not in shock 1

• For patients with dengue shock syndrome:

  • Administer an initial fluid bolus of 20 mL/kg with careful reassessment afterward 1
  • Use crystalloid solutions as first-line therapy for moderate shock 1
  • Consider colloid solutions for severe shock when available 1

Medication Considerations

• Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) due to increased bleeding risk 1, 4
• Use acetaminophen/paracetamol for fever and pain management 1
• No specific antiviral therapy is currently approved for dengue treatment 3, 5

Management of Complications

• For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1
• Blood transfusion may be necessary in cases of significant bleeding 1
• Monitor for and manage fluid overload, especially during the recovery phase 1

Monitoring Parameters

• Clinical indicators of adequate tissue perfusion: normal capillary refill time, absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, normal mental status, and adequate urine output 1
• Laboratory parameters: platelet count, hematocrit, white blood cell count, liver function tests 2, 1

Common Pitfalls to Avoid

• Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
• Administering excessive fluid boluses in patients without shock, which can lead to fluid overload and respiratory complications 1
• Delaying fluid resuscitation in patients with dengue shock syndrome 1
• Using aspirin or NSAIDs, which can worsen bleeding tendencies 1, 4
• Inadequate monitoring during the critical phase of illness 1

Special Considerations

• Pregnant women with suspected dengue require concurrent testing for both dengue and Zika virus due to similar clinical presentations and geographic distributions 2
• Patients with dengue should be reported to appropriate public health authorities as it is a notifiable disease in many countries 6