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
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