What is the treatment for dengue?

Treatment for Dengue

There is no specific antiviral therapy for dengue; treatment relies on symptomatic management with careful fluid resuscitation for shock, acetaminophen for fever, and strict avoidance of NSAIDs and aspirin. 1

General Management Approach

Symptomatic Care

• Use acetaminophen (paracetamol) only for fever and pain control 1, 2
• Absolutely avoid aspirin and NSAIDs (ibuprofen, naproxen, etc.) as they significantly increase bleeding risk 1, 2
• Resume age-appropriate diet as soon as appetite returns 1

Monitoring Strategy

• Perform daily complete blood counts to track platelet counts and hematocrit levels, particularly during days 3-7 of illness (the critical phase when plasma leakage occurs) 1, 2
• Watch for warning signs of progression to severe disease: persistent vomiting, severe abdominal pain, lethargy or restlessness, mucosal bleeding, and rising hematocrit with rapidly falling platelet count 1

Fluid Management Algorithm

For Patients WITHOUT Shock

• Oral rehydration is first-line therapy 1, 3
• Target fluid intake of approximately 2,500-3,000 mL daily (encourage 5 or more glasses throughout the day) 1
• Use any locally available fluids: water, oral rehydration solutions, cereal-based gruels, soup, rice water 1
• Avoid soft drinks due to high osmolarity 1
• Do NOT give routine bolus IV fluids to patients with severe febrile illness who are not in shock—this increases risk of fluid overload and respiratory complications without improving outcomes 1, 3

For Dengue Shock Syndrome (Hypotension or Narrow Pulse Pressure)

• Immediately administer 20 mL/kg of isotonic crystalloid (Ringer's lactate or 0.9% normal saline) as rapid bolus over 5-10 minutes 1, 3, 2
• Reassess after each bolus for signs of improvement: improved tachycardia, tachypnea, capillary refill, mental status 1
• If shock persists, repeat crystalloid boluses up to total of 40-60 mL/kg in the first hour 1
• Colloids (dextran, gelafundin, or albumin) 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

Monitoring During Resuscitation

• Watch for signs of adequate perfusion: normal capillary refill, absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, return to baseline mental status, adequate urine output (>0.5 mL/kg/hour in adults) 1, 2
• Stop fluid resuscitation immediately if hepatomegaly, pulmonary rales, or respiratory distress develop—these signal fluid overload 1

Refractory Shock Management

• If shock persists despite adequate fluid resuscitation, initiate vasopressors immediately (delays increase mortality) 1
• For cold shock with hypotension: use epinephrine as first-line vasopressor 1
• For warm shock with hypotension: use norepinephrine as first-line vasopressor 1
• Begin peripheral inotropic support if central venous access is not readily available 1

Management of Complications

Bleeding

• Blood transfusion may be necessary for significant bleeding 1, 3, 2
• Continue strict avoidance of antiplatelet agents and NSAIDs 1, 3

Fluid Overload

• Avoid overhydration, particularly during the recovery phase, as it can lead to pulmonary edema 1
• If fluid overload develops, switch from fluids to inotropic support 1

Discharge Criteria

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

• Afebrile for at least 48 hours without antipyretics 2
• Resolution or significant improvement of symptoms 2
• Improved general condition and return to baseline mental status 2
• Laboratory tests returning to normal ranges 2
• Stable hemodynamic parameters for at least 24 hours without support 2
• Adequate urine output (>0.5 mL/kg/hour in adults) 2

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

Critical Pitfalls to Avoid

• Never delay fluid resuscitation in established dengue shock syndrome—once hypotension occurs, cardiovascular collapse may rapidly follow 1
• Never use restrictive fluid strategies in dengue shock syndrome; three RCTs demonstrate near 100% survival with aggressive fluid management 1
• Never give excessive fluid boluses to patients without shock—this leads to fluid overload and respiratory complications 1, 3
• Never fail to recognize the critical phase (days 3-7 of illness) when plasma leakage can rapidly progress to shock 1, 3
• Never continue aggressive fluid resuscitation once signs of fluid overload appear 1