dengue
DENGUE

Dengue infection is caused by the dengue virus that belongs to the family Flaviviridae. It is generally self-limiting and rarely fatal.
There are 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4). Infection w/ dengue serotype confers lifetime protective immunity to that specific serotype; cross-protection for other serotypes is only short-term.
It is transmitted to humans through the bites of infected Aedes mosquitoes. It is primarily transmitted by female Aedes aegypti, a tropical and subtropical species.Humans & monkeys are the amplifying hosts after the mosquito bite.
After 4-10 days of incubation period, illness begins immediately.
The acute phase of illness lasts for 3-7 days, but the convalescent phase may be prolonged for a week and may be associated with weakness and depression especially in adults.

Pharmacotherapy

Dengue Fever (DF)

Antipyretics & Analgesics

  • Preferably, give Paracetamol to keep the body temperature below 40°C & to relieve body ache
  • Avoid Aspirin & other salicylates since these may cause gastritis, bleeding & acidosis
  • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs); aside from possibly causing gastritis, gastrointestinal tract (GIT) bleeding & acidosis, NSAIDs also have an antiplatelet effect

Sedatives

  • Give mild sedatives for patients with severe pain

Dengue Hemorrhagic Fever (DHF)

Antipyretics

  • Paracetamol is recommended & should be used to keep the temperature below 39°C
  • Antipyretics do not shorten the duration of fever in DHF
  • Indicated for patients with hyperpyrexia particularly those with history of febrile convulsions
  • Avoid aspirin & other salicylates since these may cause gastritis, bleeding & acidosis
  • Avoid NSAIDs; causes gastritis, GIT bleeding & acidosis, & may have antiplatelet effects

Dengue Shock Syndrome (DSS)

Sedatives

  • Necessary to calm agitated patients especially children

Non-Pharmacological Therapy

 Blood Transfusion

  • All patients with severe dengue should be admitted to hospitals with access to intensive care facilities & blood transfusion
  • Blood transfusions should be given only in cases with suspected/severe bleeding
    • Fresh whole blood or fresh packed red cells is preferable
    • May give 5-10 mL/kg of fresh packed red cells or 10-20 mL/kg of fresh whole blood
    • Observe for clinical response
  • A decrease in hematocrit associated with unstable vital signs (eg tachycardia, narrowing of pulse pressure, metabolic acidosis, poor urine output) indicates major bleeding & the need for urgent blood transfusion
  • Do not wait for the hematocrit to drop too low before initiating blood transfusion
  • However, it must be given with care due to the risk of fluid overload
  • Consider repeating blood transfusion if there is further blood loss or no appropriate rise in hematocrit after blood transfusion
  • There is little evidence to support the use of platelet concentrates &/or fresh-frozen plasma for severe bleeding
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Infectious Diseases - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
13 Oct 2017
Use of systemic antibiotics, in conjunction with performance of incision and drainage, in the management of paediatric acute skin and soft tissue infection (SSTI) appears to reduce Staphylococcus aureus colonization and the likelihood of infection recurrence, a prospective study has found.
12 Oct 2017
Retreatment with ledipasvir and sofosbuvir with add-on ribavirin appears to be effective and well tolerated in genotype 1 hepatitis C virus (HCV)-infected patients who have failed to respond to daclatasvir/asunaprevir combination therapy, according to a study.
Elaine Tan, 14 Aug 2017

Complicated and uncomplicated urinary tract infections (UTIs) in adults and children should be managed by identifying and treating predisposing or underlying risk factors, with antimicrobial treatment, if needed, based on urine culture results and regional antibiotic resistance patterns, according to new guidelines of the Urological Association of Asia (UAA) and Asian Association of UTI and STD (AAUS).

5 days ago
Excessive intake of the mineral manganese can be toxic to the heart, according to a new study.