Treatment Guidelines for Dengue Fever
The cornerstone of dengue fever management is symptomatic treatment with careful fluid management, as there is currently no specific antiviral therapy approved for dengue. 1, 2
Clinical Presentation and Diagnosis
- Dengue fever presents with fever, headache, retro-orbital pain, myalgia, arthralgia, and rash, with symptoms ranging from mild febrile illness to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) 1
- Diagnosis is confirmed by positive PCR (within first 5-7 days of illness) or IgM capture ELISA (after 5-7 days of symptoms) 1
- The disease characteristically takes a triphasic course: febrile phase, critical phase, and recovery phase 3
Risk Stratification and Monitoring
- Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels 1, 2
- Monitor for warning signs of severe dengue, including:
- Patients should be classified into risk groups based on clinical findings and comorbidities to determine appropriate treatment setting (outpatient vs. hospital) 3
Fluid Management
Non-Shock Patients
- Ensure adequate oral hydration with more than 2500ml daily 1
- Use oral rehydration solutions for moderate dehydration 1, 4
- A fluid chart may help improve oral fluid intake and potentially reduce hospitalization and IV fluid requirements 4
- Avoid routine use of bolus intravenous fluids in patients with "severe febrile illness" who are not in shock 2
Dengue Shock Syndrome
- Administer an initial fluid bolus of 20 mL/kg with careful reassessment afterward 1, 2
- For moderate dengue shock syndrome, crystalloid solutions are recommended as first-line treatment 2
- For severe shock, consider using colloid solutions when available 1, 2
- For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1, 2
Pain and Fever 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 1, 5
- Monitor liver function tests when using acetaminophen, particularly in patients with pre-existing liver disease 5
- Avoid aspirin and NSAIDs under any circumstances due to increased bleeding risk 1, 2, 5
Management of Complications
- For significant bleeding, blood transfusion may be necessary 1, 2
- Avoid overhydration, which can lead to pulmonary edema, particularly during the recovery phase 2
- In cases of severe fluid leakage leading to pulmonary edema, carefully consider the addition of vasopressors 6
Monitoring Parameters for Treatment Response
- 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 2
Discharge Criteria
- Afebrile for at least 48 hours without antipyretics 1
- Resolution or significant improvement of symptoms 1
- Improved general condition and return to baseline mental status 1
- Laboratory tests returning to normal ranges 1
- Stable hemodynamic parameters for at least 24 hours without support 1
- Adequate urine output (>0.5 mL/kg/hour in adults) 1
Common Pitfalls to Avoid
- Using aspirin or NSAIDs which can worsen bleeding tendencies 1, 2, 5
- Delaying fluid resuscitation in patients with dengue shock syndrome 1, 2
- Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 2
- Administering excessive fluid boluses in patients without shock, which can lead to fluid overload and respiratory complications 2
- Inadequate monitoring during the critical phase of illness 2