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.

Keywords: Dengue; Management; Shock.

Fig. 1

Algorithm for management of compensated shock. HCT Hematocrit, IV Intravenous. (Adapted from: Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. New ed. Geneva, Switzerland: WHO 2009 [2])

Fig. 2

Algorithm for management of uncompensated shock. HCT Hematocrit, IV Intravenous. (Adapted from: Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. New ed. Geneva, Switzerland: WHO 2009 [2])