What are the guidelines for managing dengue fever?

Guidelines for Managing Dengue Fever

The cornerstone of dengue fever management is supportive care with careful monitoring, as there is no specific antiviral therapy currently approved. 1

Clinical Presentation and Diagnosis

• Dengue fever presents with fever, headache, retro-orbital pain, myalgia, arthralgia (particularly back pain), and rash 2
• The spectrum ranges from mild febrile illness to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) 2
• Incubation period is 4-8 days (range: 3-14 days) 2
• Diagnosis is confirmed by positive PCR (early) or IgM capture ELISA (if symptoms present >5-7 days) 2

Monitoring Recommendations

• Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels 1, 3
• Monitor for warning signs of severe dengue, including:
  • Persistent vomiting and abdominal pain 1
  • Lethargy or restlessness 1
  • Mucosal bleeding 1
  • Rising hematocrit with falling platelet count 1, 4

Fluid Management

• For patients without shock:

  • Ensure adequate oral hydration 5, 1
  • Use oral rehydration solutions for moderate dehydration 5, 1
  • Consider using a fluid chart to track intake (aim for >2500ml daily) 6

• For dengue shock syndrome:

  • Administer initial fluid bolus of 20 mL/kg with careful reassessment afterward 1, 2
  • For severe shock, colloid solutions may be beneficial when available 1, 7
  • For moderate shock, crystalloid solutions are first-line 1
  • Avoid excessive fluid boluses in patients without shock to prevent fluid overload 1, 7

Pain Management

• 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 relief 5, 1
• Avoid aspirin and NSAIDs due to increased bleeding risk 5, 1
• Monitor liver function tests when using acetaminophen, particularly in patients with pre-existing liver disease 5

Management of Complications

• For significant bleeding:

  • Blood transfusion may be necessary 1, 4
  • Fresh frozen plasma and platelet transfusions may be required in patients who develop DIC 4

• For persistent tissue hypoperfusion despite adequate fluid resuscitation:

  • Vasopressors such as dopamine or epinephrine may be required 1
  • Oxygen is mandatory in all patients with shock 4

• For polyserositis (pleural effusion and ascites):

  • Avoid drainage if possible as it can lead to severe hemorrhages and sudden circulatory collapse 4

Common Pitfalls to Avoid

• Do not use aspirin or NSAIDs under any circumstances due to high bleeding risk 5, 1
• Avoid delaying fluid resuscitation in patients showing signs of shock 1, 4
• Do not fail to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
• Avoid overhydration, which can lead to pulmonary edema, particularly during the recovery phase 1, 7
• Do not administer excessive fluid boluses in patients without shock 1

Special Populations

• For pregnant women with dengue fever, acetaminophen remains the safest analgesic option 5
• In children, acetaminophen dosing should be carefully calculated based on weight (10-15 mg/kg per dose) 5

Prevention

• Meticulous avoidance of mosquito bites is essential for prevention 8
• Day-biting mosquitoes of the genus Aedes, particularly Aedes aegypti, are the primary vectors 2, 8