What is the treatment for dengue fever?

Treatment of Dengue Fever

The treatment of dengue fever is primarily supportive, focusing on adequate hydration, acetaminophen for pain and fever relief, and careful monitoring for complications, as there is no specific antiviral therapy available. 1, 2

Clinical Presentation and Diagnosis

• Dengue fever presents with fever, headache, retro-orbital pain, myalgia (muscle pain), arthralgia (joint pain), and rash, with symptoms ranging from mild febrile illness to severe forms including dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). 1
• Diagnosis is confirmed by positive PCR in early disease (≤7 days after symptom onset) or IgM capture ELISA for patients with symptoms present for more than 5-7 days. 1, 2
• The disease typically follows a triphasic course: febrile phase, critical phase, and recovery phase. 3

Treatment Approach

Fluid Management

• For patients without shock: Ensure adequate oral hydration with more than 2500ml daily and use oral rehydration solutions for moderate dehydration. 1, 2
• For dengue shock syndrome: Administer an initial fluid bolus of 20 mL/kg crystalloid with careful reassessment afterward. Consider colloid solutions for severe shock when available. 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, 4, 2
• Never use aspirin or NSAIDs under any circumstances due to increased bleeding risk. 1, 4, 2

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 persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding, and rising hematocrit with falling platelet count. 1, 2

Management of Complications

Bleeding

• For significant bleeding, blood transfusion may be necessary. 1, 2

Shock

• For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required. 1, 2

Respiratory Distress

• For patients with respiratory distress and/or persistent hypoxemia despite oxygen therapy, consider non-invasive ventilation if available. 2
• If intubation is necessary, ketamine with atropine premedication is suggested for sedation to maintain cardiovascular stability. 2

Special Populations

Pregnant Women

• Acetaminophen remains the safest analgesic option for pregnant women with dengue fever. 1, 4, 2

Children

• In children, acetaminophen dosing should be carefully calculated based on weight (10-15 mg/kg per dose). 1, 4, 2
• Careful fluid management is particularly important in children with dengue shock syndrome. 2

Discharge Criteria

• Patients can be discharged when they have been afebrile for at least 48 hours without antipyretics. 1
• Resolution or significant improvement of symptoms, improved general condition, and return to baseline mental status are required. 1
• Laboratory tests previously abnormal should be returning to normal ranges. 1
• Stable hemodynamic parameters for at least 24 hours without support are necessary. 1
• Adequate urine output (>0.5 mL/kg/hour in adults) is required. 1

Common Pitfalls to Avoid

• Using aspirin or NSAIDs due to high bleeding risk. 1, 4
• Delaying fluid resuscitation in patients showing signs of shock. 1, 4
• Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock. 4
• Changing antibiotics or management based solely on persistent fever pattern without clinical deterioration or new findings. 1

Prevention

• Day-biting mosquitoes of the genus Aedes, particularly Aedes aegypti, are the primary vectors of dengue fever. Prevention focuses on mosquito control and avoiding bites. 1, 3