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 management, and careful monitoring for complications, as no specific antiviral therapy is currently available. 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 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

Management Approach

Fluid Management

• For patients without shock:

  • Ensure adequate oral hydration with more than 2500ml daily 1, 2
  • Use oral rehydration solutions for moderate dehydration 1, 4

• For dengue shock syndrome:

  • Administer an initial fluid bolus of 20 mL/kg crystalloid with careful reassessment 1, 2
  • Consider colloid solutions for severe shock when available 1

Pain and Fever Management

• Acetaminophen (paracetamol) at standard doses is the first-line recommendation:
  • Adults: 10-15 mg/kg every 4-6 hours, not exceeding 4 g/day 4
  • Children: 10-15 mg/kg per dose, carefully calculated based on weight 4, 2
• Monitor liver function tests when using acetaminophen, particularly in patients with pre-existing liver disease 4

Monitoring Recommendations

• Perform daily complete blood count monitoring to track platelet counts and hematocrit levels 1, 4, 2
• Monitor for warning signs of severe dengue, including:
  • Persistent vomiting
  • Abdominal pain
  • Lethargy or restlessness
  • Mucosal bleeding
  • Rising hematocrit with falling platelet count 1, 4

Management of Complications

• For significant bleeding, blood transfusion may be necessary 1, 2
• For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1, 2
• For respiratory distress with persistent hypoxemia, consider non-invasive ventilation if available 2

Special Populations

• Pregnant women: Acetaminophen remains the safest analgesic option 1, 4, 2
• Children: Careful fluid management is particularly important in dengue shock syndrome 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 previously abnormal 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

• Never use aspirin or NSAIDs under any circumstances due to increased bleeding risk 1, 4, 2
• Do not delay fluid resuscitation in patients showing signs of shock 1, 4
• Do not fail to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 4
• Avoid changing antibiotics or management based solely on persistent fever pattern without clinical deterioration 1

Prevention

• Day-biting mosquitoes of the genus Aedes, particularly Aedes aegypti, are the primary vectors of dengue fever 1, 3
• Preventive measures include meticulous avoidance of mosquito bites 3