What is the treatment for symptoms of dengue (Dengue virus) or chikungunya (Chikungunya virus)?

Treatment of Dengue and Chikungunya Symptoms

Use acetaminophen exclusively for pain and fever relief in both dengue and chikungunya patients, never aspirin or NSAIDs, and focus on aggressive hydration with oral rehydration solutions targeting >2500ml daily for non-severe cases. 1, 2

Pain and Fever Management

• Acetaminophen at standard doses is the only acceptable analgesic for both dengue and chikungunya patients 1, 2, 3
• Absolutely avoid aspirin and NSAIDs due to increased bleeding risk and platelet dysfunction in dengue patients 1, 2, 3
• For pregnant women, acetaminophen remains the safest option 1, 2
• In children, calculate acetaminophen dosing carefully based on weight 1, 2

Hydration Strategy

For non-severe cases:

• Ensure adequate oral hydration with oral rehydration solutions for moderate dehydration 1, 2
• Target fluid intake exceeding 2500ml daily 1, 2, 3

For dengue shock syndrome:

• Administer initial fluid bolus of 20 mL/kg over 5-10 minutes with immediate reassessment 1, 3
• Consider colloid solutions for severe shock when available 1, 2
• If persistent tissue hypoperfusion occurs despite adequate fluid resuscitation, use vasopressors (dopamine or epinephrine) 1, 3

Monitoring Requirements for Dengue

• Perform daily complete blood count to track platelet counts and hematocrit levels 1, 2
• Monitor continuously for warning signs: persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding, rising hematocrit with falling platelet count 1, 2, 3
• Use continuous cardiac telemetry and pulse oximetry for dengue shock syndrome 1, 2

Management of Bleeding Complications

• For significant bleeding in dengue, blood transfusion may be necessary with close monitoring of hemoglobin and hematocrit 2, 3

Key Clinical Differences

While treatment is similar, chikungunya patients more commonly present with joint and back pain, whereas dengue patients more frequently have headache, muscle pain, nausea/vomiting, diarrhea, and hemorrhagic signs 4. Platelet count <118 × 10⁹/L strongly suggests dengue over chikungunya 5.

Discharge Criteria for Dengue

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

• Afebrile for at least 48 hours without antipyretics 1, 2, 3
• Resolution or significant improvement of symptoms 1, 2, 3
• Laboratory parameters returning to normal ranges 1, 2, 3
• Stable hemodynamic parameters for at least 24 hours without support 1, 2, 3
• Adequate urine output (>0.5 mL/kg/hour in adults) 1, 2

Critical Pitfalls to Avoid

• Never use aspirin or NSAIDs under any circumstances due to high bleeding risk 2, 3
• Do not delay fluid resuscitation in patients showing signs of shock 2
• Do not change management based solely on persistent fever without clinical deterioration or new findings 2