What is the treatment for dengue fever?

Treatment of Dengue Fever

The cornerstone of dengue fever treatment is symptomatic management with acetaminophen for pain and fever, adequate hydration, and close monitoring for warning signs of progression to severe disease, as there is no specific antiviral therapy currently approved. 1

Clinical Presentation and Diagnosis

• Dengue fever typically presents with fever, severe myalgia (muscle pain), arthralgia (joint pain), headache, retro-orbital pain, and rash 2
• Diagnosis is made through direct demonstration of the pathogen (e.g., RT-PCR up to day 5 of illness) or serology 3
• The disease characteristically takes a triphasic course: febrile phase, critical phase, and recovery phase 3

First-Line Treatment Approach

• Acetaminophen (paracetamol) at standard doses (10-15 mg/kg every 4-6 hours, not exceeding 4 g/day in adults) is recommended for pain and fever management 2
• Aspirin and NSAIDs must be strictly avoided due to increased bleeding risk 2, 1
• Adequate hydration is essential - oral rehydration is appropriate for patients without signs of shock 1
• Daily complete blood count monitoring is crucial, particularly to track platelet counts and hematocrit levels 1, 4

Management Based on Disease Severity

Mild/Moderate Dengue (Outpatient Management)

• Maintain adequate oral hydration with fluids containing electrolytes 4
• Regular monitoring for warning signs of severe disease 4
• Daily follow-up with complete blood count to track platelet trends 1

Severe Dengue (Inpatient Management)

• For dengue shock syndrome, administer an initial fluid bolus of 20 mL/kg with careful patient reassessment afterward 1
• For severe shock, colloid solutions may be beneficial when available 1
• For moderate shock, crystalloid solutions are recommended as first-line 1
• Blood transfusion may be necessary in cases of significant bleeding 1

Monitoring for Complications

• Watch for warning signs of progression to severe disease: 1, 4

  • High hematocrit with rapidly falling platelet count
  • Severe abdominal pain
  • Persistent vomiting
  • Lethargy or restlessness
  • Mucosal bleeding
  • Cold, clammy extremities
  • Rising hematocrit (>20% increase from baseline)

• Monitor 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

Common Pitfalls to Avoid

• Using aspirin or NSAIDs, which can worsen bleeding tendencies 2, 1
• Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
• Delaying fluid resuscitation in patients with dengue shock syndrome 1
• Administering excessive fluid boluses in patients without shock, which can lead to fluid overload and respiratory complications 1
• Overhydration during the recovery phase, which can lead to pulmonary edema 1

Special Considerations

• For pregnant women, acetaminophen remains the safest analgesic option 2
• In children, acetaminophen dosing should be carefully calculated based on weight (10-15 mg/kg per dose) 2
• For patients with persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1

Prognosis

• Dengue fever takes a mild course in more than 90% of cases 3
• Severe dengue fever, including shock and/or mucosal hemorrhages, is rare and carries a mortality of 1-5% 3
• With appropriate supportive care and early recognition of warning signs, most patients recover without complications within 1-2 weeks 4