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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 with 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 and 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.

Dengue Treatment

Treatment

Pharmacotherapy

Dengue Fever (DF)

Antipyretics and Analgesics

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

Sedatives

Give mild sedatives for patients with severe pain

Dengue Hemorrhagic Fever (DHF)

Antipyretics

Paracetamol is recommended and 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 and other salicylates since these may cause gastritis, bleeding and acidosis
Avoid NSAIDs; causes gastritis, GIT bleeding and acidosis, and 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 and 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 and 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 and/or fresh-frozen plasma for severe bleeding

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