From the Guidelines
Dengue fever is characterized by an acute febrile illness with symptoms including frontal headache, retro-ocular pain, muscle and joint pain, and rash, as defined by the Centers for Disease Control and Prevention 1. Dengue fever typically presents with a sudden onset of high fever, severe headache, pain behind the eyes, and intense muscle and joint pain. Other common symptoms include:
- Fatigue
- Nausea
- Vomiting
- Skin rash that appears 2-5 days after fever onset
- Mild bleeding such as nose bleeds, bleeding gums, or easy bruising Some patients may develop warning signs of severe dengue, including:
- Severe abdominal pain
- Persistent vomiting
- Rapid breathing
- Bleeding gums
- Fatigue
- Restlessness
- Blood in vomit or stool The fever typically lasts 2-7 days, and symptoms generally resolve within 1-2 weeks. It is crucial to seek medical attention promptly if dengue is suspected, and to stay hydrated and use acetaminophen (paracetamol) for fever and pain relief while avoiding aspirin and NSAIDs due to increased bleeding risk 1.
From the Research
Dengue Symptoms and Treatment
- Dengue fever is a disease that requires proper management of its symptoms, including pain and fever.
- The World Health Organization and US Centers for Disease Control recommend acetaminophen for managing pain and fever, but contraindicate nonsteroidal anti-inflammatory agents (NSAIDs) due to potentially increased bleeding risk, with thrombocytopenia as a complication 2.
- However, epidemiologic and cohort studies, and case series describing NSAID use in dengue, generally point to minimal or no significant increase in bleeding risk, except for aspirin 2.
Bleeding Risk with NSAID Use
- The risk of postoperative bleeding with NSAID use, particularly ibuprofen, has been assessed as a potential surrogate marker of bleeding risk in dengue 2.
- Ibuprofen at over-the-counter doses used to treat pain and fever is associated with zero to minimally increased risk for postoperative bleeding events 2.
- Statistically significant increases in bleeding incidence and/or bleed volume were not clinically meaningful, where detected 2.
Comparison of Acetaminophen and Ibuprofen
- Acetaminophen-associated hepatotoxicity raises the possibility of severe hepatic injury with acetaminophen treatment, particularly in patients with chronic liver damage 2.
- Meta-analyses of clinical studies consistently conclude that ibuprofen, at non-prescription doses, provides equivalent or superior analgesic and antipyretic activity compared with acetaminophen, with comparable safety 2.
- These data suggest that the consensus guideline recommendations for acetaminophen and against NSAID use in dengue treatment should be reconsidered in light of current evidence regarding the risks and benefits of each agent 2.