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!
Sign In To Download
Editor's Recommendations
Most Read Articles
07 Oct 2018
Patients using long-acting opioids with immunosuppressive properties are at greater risk of developing serious infections compared with those using the nonimmunosuppressive opioid counterpart, according to a study.
30 Aug 2017
Admissions to the hospital for cellulitis appear to greatly increase with warmer weather, suggesting that warmer weather is a risk factor for the infectious disease, according to a study.
Roshini Claire Anthony, 06 Mar 2019

Older adults who are diagnosed with cancer appear to have an elevated risk of developing zoster, particularly those diagnosed with haematological cancers, according to findings of an Australian study.

Stephen Padilla, 18 Feb 2019
A higher frequency of enterovirus, but not adenovirus, infection during early childhood may increase the risk of later coeliac disease, suggests a recent study, adding new data on the role of viral infections in the aetiology of coeliac disease.