Latest Treatment for Dengue Virus Infection
The cornerstone of dengue treatment is supportive care with judicious fluid management, acetaminophen for pain and fever, and careful monitoring for complications, as there are currently no specific antiviral medications available for dengue. 1, 2
Clinical Classification and Assessment
- Dengue is classified into probable dengue, dengue with warning signs, and severe dengue according to WHO classification 2
- Diagnosis is confirmed by positive PCR (within first 5-7 days) or IgM capture ELISA (after 5-7 days of symptoms) 1
- Warning signs of severe dengue include persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding, and rising hematocrit with falling platelet count 1
Fluid Management
- For patients without shock: ensure adequate oral hydration with oral rehydration solutions, aiming for more than 2500ml daily 1
- For dengue shock syndrome: administer an initial fluid bolus of 20 mL/kg with careful reassessment afterward 3, 1
- Crystalloids are the initial fluid of choice for resuscitation 2
- In severe shock, colloid solutions may be considered when available 1
- In resource-limited settings without access to critical care resources, fluid boluses should be administered with extreme caution as they may be harmful 3
Monitoring Recommendations
- Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels 1
- Reassess patients after every fluid bolus to prevent fluid overload 3
- Monitor for signs of plasma leakage, which indicates increased risk of complications 1
Pain and Fever Management
- Acetaminophen at standard doses is recommended for pain and fever relief 1
- Avoid aspirin and NSAIDs completely due to increased bleeding risk 1, 4
Management of Complications
- For significant bleeding, blood transfusion may be necessary 1
- For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1
- Secondary hemophagocytic lymphohistiocytosis is a potentially fatal complication that may require specific management with steroids or intravenous immunoglobulin 2
Common Pitfalls to Avoid
- Do not use aspirin or NSAIDs under any circumstances due to high bleeding risk 1, 4
- Do not delay fluid resuscitation in patients showing signs of shock 1
- Avoid prophylactic platelet transfusion (not recommended) 2
- Avoid hepatotoxic medications in patients with dengue hepatitis 4
Discharge Criteria
- Patients can be discharged when:
Post-Discharge Instructions
- Monitor and record temperature twice daily 1
- Return to healthcare facility if temperature rises to ≥38°C on two consecutive readings or if any warning signs develop 1