What is the treatment for Dengue (Dengue Fever)?

Treatment of Dengue Fever

Dengue treatment is entirely supportive and symptomatic, as no specific antiviral therapy is currently approved—the cornerstone is careful fluid management, acetaminophen for pain/fever, and vigilant monitoring for progression to severe disease. 1, 2, 3

General Management Principles

• Symptomatic management is the only available treatment since no antiviral therapy exists for dengue infection 1, 2, 3
• Acetaminophen (paracetamol) at standard doses is the only acceptable analgesic for pain and fever relief 1, 4, 5
• Aspirin and NSAIDs must be strictly avoided due to significantly increased bleeding risk from platelet dysfunction and potential hemorrhagic complications 1, 4, 5, 6
• Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels, particularly during the critical phase (days 3-7 of illness) 1, 4, 5

Fluid Management Strategy

For Patients Without Shock

• Ensure adequate oral hydration with oral rehydration solutions, aiming for more than 2500 mL daily intake 1, 4, 5
• Oral rehydration is appropriate for patients without signs of shock or warning signs 1
• Avoid routine bolus intravenous fluids in patients with febrile illness who are not in shock, as this can lead to fluid overload 1

For Dengue Shock Syndrome

• Administer an initial fluid bolus of 20 mL/kg crystalloid solution with careful patient reassessment afterward 1, 4, 5
• Crystalloid solutions (normal saline or Ringer's lactate) are first-line for moderate shock 1
• Colloid solutions may be beneficial for severe dengue shock syndrome when available 1, 4
• For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors such as dopamine or epinephrine may be required 1, 4

Critical Monitoring Parameters

Warning Signs Requiring Immediate Attention

• Monitor for clinical indicators of progression to severe disease: persistent vomiting, severe abdominal pain, lethargy or restlessness, mucosal bleeding, and high hematocrit with rapidly falling platelet count 1, 4, 5
• Watch for signs 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, and adequate urine output (>0.5 mL/kg/hour in adults) 1, 4

Laboratory Monitoring

• Daily complete blood count to track platelet counts and hematocrit levels 1, 4
• Rising hematocrit with falling platelet count indicates plasma leakage and impending shock 1, 4

Management of Complications

• Blood transfusion may be necessary in cases of significant bleeding with close monitoring of hemoglobin and hematocrit 1, 4, 5
• Consider abdominal ultrasound to evaluate for ascites, hepatomegaly, and plasma leakage if severe abdominal pain develops 5
• For severe pain not responding to acetaminophen, opioid analgesics may be considered with careful monitoring 5

Critical Pitfalls to Avoid

• Administering excessive fluid boluses in patients without shock leads to fluid overload and pulmonary edema, particularly during the recovery phase 1, 5
• Failing to recognize the critical phase (days 3-7 of illness) when plasma leakage can rapidly progress to shock is a common error 1, 4
• Never use aspirin or NSAIDs under any circumstances due to high bleeding risk 1, 4, 5, 6
• Delaying fluid resuscitation in patients with dengue shock syndrome significantly worsens outcomes 1, 5
• Inadequate monitoring during the critical phase of illness can miss early signs of deterioration 1, 4

Discharge Criteria

Patients can be discharged when ALL of the following are met:

• Afebrile for at least 48 hours without antipyretics 4
• Resolution or significant improvement of symptoms including abdominal pain 4, 5
• Stable hemodynamic parameters for at least 24 hours without support (normal heart rate, blood pressure, capillary refill) 4
• Adequate oral intake and urine output (>0.5 mL/kg/hour) 4
• Laboratory parameters returning to normal ranges 4

Post-Discharge Instructions

• Monitor and record temperature twice daily 4
• Return immediately if temperature rises to ≥38°C on two consecutive readings or if any warning signs develop (persistent vomiting, severe abdominal pain, bleeding, lethargy) 4

Diagnostic Confirmation

• For patients presenting ≤7 days after symptom onset, nucleic acid amplification tests (NAATs/PCR) on serum are the preferred diagnostic method 7, 4
• For patients presenting >7 days after symptom onset or with negative NAAT results, IgM antibody testing should be performed 7
• Cross-reactivity with other flaviviruses (yellow fever, Japanese encephalitis, Zika) complicates antibody interpretation, so vaccination history is essential 7