What is the treatment for Dengue (Dengue Fever)?

Treatment of Dengue Fever

Dengue treatment is primarily supportive with no specific antiviral therapy available, focusing on symptomatic management with acetaminophen for fever/pain, careful fluid management based on disease severity, and strict avoidance of aspirin and NSAIDs due to bleeding risk. 1, 2

Symptomatic Management

Pain and Fever Control

• Acetaminophen at standard doses is the only recommended analgesic for dengue fever 1, 2, 3
• Aspirin and all NSAIDs must be strictly avoided under any circumstances due to increased bleeding risk with thrombocytopenia 1, 2, 3, 4
• This prohibition applies even when dengue cannot be definitively excluded in the differential diagnosis 3

Hydration Strategy for Non-Severe Cases

• Ensure adequate oral hydration with oral rehydration solutions for patients without shock, targeting more than 2500 mL daily 2
• Oral rehydration is appropriate for patients without warning signs of progression 1

Monitoring Requirements

Laboratory Surveillance

• Daily complete blood count monitoring is essential to track platelet counts and hematocrit levels in all patients at risk of progression 1, 2, 3
• Diagnosis is confirmed by positive PCR if tested early, or IgM capture ELISA if symptoms have been present for over 5-7 days 5, 2

Warning Signs Requiring Escalation

Monitor closely for these indicators of progression to severe disease 1, 2, 3:

• Persistent vomiting or severe abdominal pain
• Lethargy, restlessness, or altered mental status
• Mucosal bleeding
• High hematocrit with rapidly falling platelet count
• Hepatomegaly or signs of plasma leakage

Fluid Management for Dengue Shock Syndrome

Initial Resuscitation

• Administer 20 mL/kg of isotonic crystalloid as initial bolus over 5-10 minutes with immediate reassessment 1, 2, 3
• If shock persists after initial bolus, repeat crystalloid boluses up to 40-60 mL/kg in the first hour may be necessary 1
• Colloid solutions (gelafundin, albumin, or dextran) provide faster resolution of shock compared to crystalloids alone (RR 1.09,95% CI 1.00-1.19) and reduce total volume needed (mean 31.7 mL/kg versus 40.63 mL/kg) 1

Vasopressor Support for Refractory Shock

• For cold shock with hypotension: titrate epinephrine as first-line vasopressor 1
• For warm shock with hypotension: titrate norepinephrine as first-line vasopressor 1
• Target mean arterial pressure appropriate for age and maintain ScvO2 >70% 1

Monitoring During Resuscitation

Watch for clinical indicators of adequate tissue perfusion 1:

• Normal capillary refill time and absence of skin mottling
• Warm and dry extremities with well-felt peripheral pulses
• Return to baseline mental status
• Adequate urine output (>0.5 mL/kg/hour in adults)

Management of Complications

Bleeding

• Blood transfusion may be necessary in cases of significant bleeding 1, 2
• Major bleeding almost invariably occurs in combination with profound shock, thrombocytopenia, hypoxia, and acidosis 6

Persistent Tissue Hypoperfusion

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

Critical Pitfalls to Avoid

Fluid Management Errors

• Do not administer routine bolus IV fluids in patients with severe febrile illness who are NOT in shock, as this increases risk of fluid overload and respiratory complications without improving outcomes 1
• Avoid overhydration, which can lead to pulmonary edema, particularly during the recovery phase 1
• Do not continue aggressive fluid resuscitation once signs of fluid overload appear (hepatomegaly, rales, respiratory distress); switch to inotropic support instead 1
• Do not delay fluid resuscitation in patients showing signs of dengue shock syndrome 1, 3

Timing and Recognition Errors

• Do not fail to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
• Do not change antibiotics or management based solely on persistent fever pattern without clinical deterioration or new findings 2

Medication Errors

• Never use aspirin or NSAIDs when dengue cannot be excluded 3, 4
• Platelet inhibitors should be stopped when dengue infection is suspected to minimize bleeding risk 4

Discharge Criteria

Patients can be discharged when all of the following are met 2:

• Afebrile for at least 48 hours without antipyretics
• Resolution or significant improvement of symptoms
• Improved general condition and return to baseline mental status
• Laboratory parameters returning to normal ranges
• Stable hemodynamic parameters for at least 24 hours without support
• Adequate oral intake and urine output (>0.5 mL/kg/hour)

Post-Discharge Instructions

• Monitor and record temperature twice daily 2
• Return immediately if temperature rises to ≥38°C on two consecutive readings or if any warning signs develop 2

Special Populations

Pregnant Women

• Acetaminophen remains the safest analgesic option in pregnancy 2, 3
• Test by NAAT for both dengue and Zika viruses regardless of outbreak patterns due to possible adverse outcomes 3

Children

• Acetaminophen dosing should be carefully calculated based on weight 2