Management of Dengue: An Updated Review

Abstract

Dengue is an important public health problem with a wide clinical spectrum. The World Health Organization classifies dengue into probable dengue, dengue with warning signs, and severe dengue. Severe dengue, characterized by plasma leakage, severe bleeding, or organ impairment, entails significant morbidity and mortality if not treated timely. There are no definitive curative medications for dengue; management is supportive. Judicious fluid resuscitation during the critical phase of dengue is the cornerstone of management. Crystalloids are the initial fluid of choice. Prophylactic platelet transfusion is not recommended. Organ involvement in severe dengue should be carefully looked for and managed. Secondary hemophagocytic lymphohistiocytosis is a potentially fatal complication of dengue that needs to be recognized, as specific management with steroids or intravenous immunoglobulin may improve outcomes. Several compounds with anti-dengue potential are being studied; no anti-dengue drug is available so far.

Predictive Value of qSOFA Score for Mortality in Older Patients with Dengue Fever : A Retrospective Case-control Study

“…The qSOFA, comprising three vital signs directly associated with severe dengue, may account for its high speci city and NPV. Severe dengue, a critical manifestation of DF, is characterized by one or more of the following conditions: (1) signi cant plasma leakage leading to shock (known as dengue shock) and/or respiratory distress due to uid accumulation; (2) severe bleeding; and (3) pronounced organ impairment [14]. The persistence of vascular permeability and plasma leakage may progress to dengue shock syndrome, ranging from initial asymptomatic capillary leakage to compensated shock, hypotensive shock, and, ultimately, cardiac arrest [15].…”

Dengue Virus: Molecular Biology and Recent Developments in Control Strategies, Prevention, Management, and Therapeutics

“…81 Based on this observation, it was concluded that these dengue patients might be protected because of the procoagulant effect of PMPs; thus, PMPs might play a role as a biomarker to determine prophylactic platelet transfusion. 82…”

“…The most dangerous manifestation that is seen in DENV infection is dengue shock syndrome (DSS), which results in a significant rise in vascular permeability. 72 Fluid resuscitation is crucial in severe dengue management. The primary goal of this therapy is to avert the complications associated with hypovolemic shock and vascular leakage.…”

“…It has been observed that colloids are more likely to stay in circulation for a longer time and elevate the colloid oncotic pressure, therefore drawing extravasated fluid back into circulation. 72 Ringer’s lactate and normal (0.9%) saline are most commonly used in the case of dengue-related fluid resuscitation. Normal saline might also be used for initial resuscitation in an individual with normal chloride levels (95–105 mmol/L) as well as with or without hyponatremia.…”

“…As compared to mature platelets, freshly secreted platelets are physiologically more effective and larger in size. An IPF value of 10% forecasts platelet recovery within the next 72 h. 72, 77…”