What is the treatment for Dengue fever?

Treatment of Dengue Fever

The cornerstone of dengue fever treatment is symptomatic management with adequate hydration, as there is no specific antiviral therapy currently approved for this condition. 1

Diagnosis and Classification

• Dengue fever presents with fever, headache, retro-orbital pain, myalgia, arthralgia, and rash, with an incubation period of 4-8 days 2
• Diagnosis is confirmed by positive PCR (within first 7 days) or IgM capture ELISA (after 5-7 days of symptoms) 2
• Classification ranges from mild febrile illness to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) 2, 3

General Management Principles

• Symptomatic management is the primary approach, focusing on adequate hydration and fever control 1, 3
• Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels 1, 2
• Acetaminophen is recommended for pain and fever relief 2
• Avoid aspirin and other non-steroidal anti-inflammatory drugs due to increased bleeding risk 1, 2

Fluid Management Algorithm

1. For patients without shock:

   • Ensure adequate oral hydration (aim for >2500ml daily) 2
   • Use oral rehydration solutions for moderate dehydration 2

2. For patients with dengue shock syndrome:

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

Monitoring Parameters

• Watch for warning signs of progression to severe disease:

  • High hematocrit with rapidly falling platelet count
  • Severe abdominal pain
  • Persistent vomiting
  • Lethargy or restlessness
  • Mucosal bleeding 1, 2

• Monitor for clinical indicators of adequate tissue perfusion:

  • Normal capillary refill time
  • Absence of skin mottling
  • Warm and dry extremities
  • Well-felt peripheral pulses
  • Return to baseline mental status
  • Adequate urine output 1

Management of Complications

• For significant bleeding: Blood transfusion may be necessary 1, 2
• For persistent tissue hypoperfusion despite adequate fluid resuscitation: Consider vasopressors such as dopamine or epinephrine 1, 2
• Avoid overhydration, which can lead to pulmonary edema, particularly during the recovery phase 1

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
• Delaying fluid resuscitation in patients with dengue shock syndrome 1
• Using aspirin or NSAIDs, which can worsen bleeding tendencies 1, 2
• Inadequate monitoring during the critical phase of illness 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