Management of Dengue Infection

Dengue infection, a mosquito-borne viral disease caused by the dengue virus, is a significant public health concern in many tropical and subtropical regions. The disease ranges from mild, self-limiting dengue fever to severe manifestations like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), both of which can be life-threatening. Since no specific antiviral treatment for dengue is currently available, the management of dengue focuses primarily on supportive care, close monitoring of symptoms, and prevention of complications.

 

Approach to Dengue Management

Dengue fever is typically a self-limited illness, meaning that it resolves on its own without the need for extensive medical interventions. Supportive care remains the cornerstone of treatment. The primary goals in managing dengue infection are to relieve symptoms, prevent dehydration, detect and manage complications early. Although research is ongoing to develop antiviral drugs that target the dengue virus, as of now, treatment options remain supportive.

 

Supportive Care

The World Health Organization (WHO) provides extensive resources for managing dengue, which largely emphasize supportive care. Patients with dengue fever should rest, stay hydrated, and take medications to relieve pain and fever. Analgesics like acetaminophen (paracetamol) are recommended to reduce fever and alleviate pain. However, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and corticosteroids should be avoided, as they can increase the risk of bleeding complications. These medications affect platelet function and can exacerbate hemorrhagic symptoms in dengue patients.

 

Hydration and Fluid Management

One of the key aspects of dengue management is maintaining proper fluid balance. Oral rehydration therapy (ORT) is advised for patients experiencing dehydration due to high fever or vomiting, which are common symptoms in dengue. ORT helps prevent severe dehydration and can often be managed at home. However, it is important to monitor the patient's condition closely.

Healthcare providers should measure the patient’s platelet count and hematocrit levels daily from the third day of illness until 1–2 days after the fever subsides. If the patient shows signs of dehydration (such as tachycardia, prolonged capillary refill time, cool or mottled skin, or decreased urine output) or if their hematocrit is rising and platelet count is falling, it may indicate worsening of the illness, necessitating intravenous (IV) fluid administration.

For patients with moderate to severe dehydration, IV fluids such as Ringer's lactate or isotonic saline solutions are often administered in a hospital setting. Careful monitoring of fluid intake and output is essential to avoid the risk of fluid overload, especially as patients recover and begin reabsorbing extravasated fluid. Once the hematocrit falls below 40% and the patient shows signs of recovery, IV fluids should be discontinued to prevent complications related to fluid overload.

 

Managing Severe Dengue

Severe dengue, which includes dengue hemorrhagic fever and dengue shock syndrome, requires immediate medical intervention and hospitalization. These conditions can lead to life-threatening complications like plasma leakage, hemorrhage, and organ damage, which are typically observed in the later stages of the disease.

In cases of severe dengue, fluid management becomes critical, and patients may need admission to an intensive care unit (ICU). IV fluid resuscitation should be administered carefully, with boluses of 10–20 mL/kg of isotonic fluids given over 20 minutes. If the patient does not respond to this treatment and the hematocrit continues to rise, it may suggest plasma leakage, requiring plasma expanders like dextran or starch. Starch is often preferred due to fewer hypersensitivity reactions compared to dextran. If hemorrhage or coagulopathy is suspected, blood products such as fresh frozen plasma or platelet transfusions may be necessary.

For patients with internal or gastrointestinal bleeding, blood transfusions might be needed. Close monitoring of urine output, blood pressure, and oxygen levels is essential, and healthcare providers must exercise caution when placing catheters or performing invasive procedures to minimize the risk of bleeding.

 

Criteria for Discharge

Patients recovering from severe dengue or dengue shock syndrome can be considered for discharge when they meet the following criteria:

1. They have been afebrile (without fever) for at least 24 hours without the use of antipyretics.
2. They demonstrate a stable hematocrit level and have had adequate urine output for 48 hours.
3. They show clinical improvement, including an improved appetite and absence of respiratory distress.
4. Their platelet count has increased to over 50,000 cells/μL.

Patients who meet these conditions can generally be discharged safely, although follow-up care is crucial.

 

Dengue in Special Populations

Pregnant Women

Pregnant women with dengue require special attention, as the disease can be more challenging to diagnose due to the overlap of symptoms with conditions like preeclampsia, which also presents with signs such as thrombocytopenia, capillary leakage, and impaired liver function. Pregnant women with dengue should be treated with fluids and acetaminophen to manage fever. However, dengue can pose a serious risk during the third trimester, with maternal death reported in rare cases. If the mother acquires dengue in the peripartum period, newborns should be evaluated for dengue infection through serial platelet counts and serological testing.

 

Children and the Elderly

Children and the elderly are also at greater risk for severe dengue due to potentially weaker immune systems. In these populations, early identification of warning signs—such as dehydration, rising hematocrit levels, or bleeding—can prevent the progression to more severe forms of the disease. Their management is similar to adults but requires careful dosing of fluids and medications to prevent complications.

 

Role of Diet and Activity

There are no specific dietary restrictions for patients with dengue, but hydration is crucial. Patients should be encouraged to drink oral rehydration solutions, water, or fruit juices to maintain adequate fluid levels. A return of appetite is generally a positive sign of recovery, particularly after more severe forms of dengue.

In terms of activity, bed rest is advised during the symptomatic phase of dengue, especially for those suffering from dengue hemorrhagic fever or dengue shock syndrome. Gradual resumption of normal activities can begin as patients enter the recovery phase, but full recovery may take weeks or even months.

 

Conclusion

The management of dengue infection revolves around vigilant monitoring, supportive care, and timely intervention to prevent severe complications. Although the disease is often self-limiting, the potential for progression to life-threatening conditions like dengue hemorrhagic fever and dengue shock syndrome makes early detection and appropriate care critical. Hydration, careful fluid management, and avoidance of certain medications are the foundation of effective dengue management. Additionally, special populations, such as pregnant women and children, require tailored approaches to care. With ongoing research and global efforts to improve dengue control, the outlook for managing this disease continues to evolve.

1. Background of dengue infection
2. Pathophysiology of dengue infection
3. Etiology of dengue infection
4. Prognosis of dengue infection
5. Diagnostic approach for Dengue fever