What is the treatment for Dengue?

Treatment for 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 Assessment

• Dengue presents with fever, headache, retro-orbital pain, myalgia, arthralgia, and rash, with a spectrum ranging from mild febrile illness to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) 2
• Diagnosis is confirmed by nucleic acid amplification tests (NAATs) on serum collected ≤7 days after symptom onset or IgM antibody testing for patients presenting later 3
• Monitor for warning signs of severe disease: persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding, and rising hematocrit with falling platelet count 1, 2

Treatment Algorithm

Mild Dengue (No Warning Signs)

• Ensure adequate oral hydration with at least 2500ml daily 2
• Administer acetaminophen at standard doses for pain and fever relief 1, 2
• Strictly avoid aspirin and NSAIDs due to increased bleeding risk 1, 2
• Daily complete blood count monitoring to track platelet counts and hematocrit levels 1

Dengue with Warning Signs

• Initiate intravenous fluid therapy with crystalloids 1
• Monitor vital signs, urine output, and hematocrit levels every 1-2 hours 1
• Reassess clinical status and adjust fluid rates accordingly 1
• Watch for clinical indicators of adequate tissue perfusion: normal capillary refill time, absence of skin mottling, warm extremities, well-felt peripheral pulses, normal mental status, and adequate urine output 1

Severe Dengue/Dengue Shock Syndrome

• Administer an initial fluid bolus of 20 mL/kg with careful patient reassessment afterward 1
• For severe shock, consider colloid solutions when available 1
• For moderate shock, use crystalloid solutions as first-line therapy 1
• 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

Monitoring Parameters

• Daily complete blood count to track platelet counts and hematocrit levels 1, 2
• Vital signs, particularly blood pressure and pulse pressure 1
• Urine output to assess adequate hydration 1
• Clinical signs of plasma leakage: pleural effusion, ascites 2
• Bleeding manifestations: petechiae, ecchymoses, mucosal bleeding 2

Common Pitfalls to Avoid

• Administering excessive fluid boluses in patients without shock, which 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, 2
• Delaying fluid resuscitation in patients with dengue shock syndrome 1
• Inadequate monitoring during the critical phase of illness 1

Special Populations

• For pregnant women, acetaminophen remains the safest analgesic option 2
• In children, acetaminophen dosing should be carefully calculated based on weight 2
• All patients with clinically suspected dengue should receive appropriate management to monitor for shock and reduce the risk for complications resulting from plasma leakage and organ damage without waiting for diagnostic test results 3

Prognosis

• Dengue fever takes a mild course in more than 90% of cases 4
• Severe dengue fever, including shock and/or mucosal hemorrhages, is rare and carries a mortality of 1-5% when properly managed 4

The management of dengue focuses on supportive care, with fluid management being the critical intervention that reduces mortality in severe cases 5. While research into antiviral therapies continues, none are currently approved for clinical use 6, 7.