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Dengue Medication

  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 05, 2015
 

Medication Summary

No specific antiviral medication is currently available to treat dengue. The treatment of dengue fever is symptomatic and supportive in nature. Bed rest and mild analgesic-antipyretic therapy are often helpful in relieving lethargy, malaise, and fever associated with the disease. Acetaminophen (paracetamol) is recommended for treatment of pain and fever. Aspirin, other salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided.

Patients with dengue hemorrhagic fever or dengue shock syndrome may require intravenous volume replacement. Plasma volume expanders can be used in patients who do not respond to isotonic fluids.

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Analgesics

Class Summary

These agents are used to reduce fever. They inhibit prostaglandin synthesis in the central nervous system. The also inhibit hypothalamic heat-regulating center, which in turn promotes the return of the set-point temperature to normal.

Acetaminophen (Tylenol, Feverall, Acephen, Mapap)

 

Acetaminophen (paracetamol) reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating. It is used in dengue infections to relieve pain and lower temperature when fever is thought to contribute to patient discomfort.

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Crystalloids for Fluid Therapy

Class Summary

Isotonic (0.9%) sodium chloride solution or lactated Ringer solution is administered intravenously to maintain intravascular volume, blood pressure, and urine output.

Lactated Ringer solution/isotonic sodium chloride solution

 

These fluids are used to expand intravascular volume. Both fluids are essentially isotonic and have equivalent volume restorative properties. Although administration of large quantities of either fluid may lead to some differences in metabolic changes, for practical purposes and in most situations, these differences are clinically irrelevant. Importantly, no demonstrable difference in hemodynamic effect, morbidity, or mortality exists with either product.

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Volume Expanders

Class Summary

Plasma volume expanders are used in the treatment of intravascular volume deficits or shock to restore intravascular volume, blood pressure, and tissue perfusion.

Dextran 40 (LMD)

 

Dextran 40 is a polymer of glucose. When infused, it increases intravascular volume, blood pressure, and capillary perfusion. It is used to restore intravascular volume when isotonic crystalloid administration is inadequate for that purpose.

Albumin (Albuminar-5, Buminate, Plasbumin 5)

 

Human albumin is a sterile solution of albumin, which is the major plasma protein responsible for the colloid oncotic pressure of blood. It is pooled from blood, serum, plasma, or placenta from healthy donors. Infusion of albumin results in a shift of fluid from the extracellular space into the bloodstream, thereby decreasing hemoconcentration and blood viscosity.

Albumin may be administered wide open when treating shock. Patient response must be assessed before repeating the dose.

Hetastarch (Hespan, Hextend)

 

Hydroxyethyl starch is a sterile solution of the starch responsible for the colloid oncotic pressure of blood. Hetastarch produces volume expansion through its highly colloidal starch structure.

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Contributor Information and Disclosures
Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Professor of Emergency Medicine, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine; Medical Director, Fast Track, Department of Emergency Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick B Hinfey, MD Emergency Medicine Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD is a member of the following medical societies: American Academy of Emergency Medicine, Wilderness Medical Society, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Hagop A Isnar, MD, FACEP Department of Emergency Medicine, Crouse Hospital

Hagop A Isnar, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Deborah Sentochnik, MD Consulting Staff, Department of Internal Medicine, Division of Infectious Disease, The Mary Imogene Bassett Hospital

Deborah Sentochnik, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Drawing of Aedes aegypti mosquito. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Aedes aegypti mosquito. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Aedes albopictus. From CDC Public Domain.
Worldwide distribution of dengue in 2000. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Worldwide distribution of dengue in 2003. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Worldwide distribution of dengue in 2005. Picture from the Centers for Disease Control and Prevention (CDC) Web site.
Increasing rates of dengue infection by regions of the world. Graphs from the World Health Organization (WHO) Web site.
Dengue transmission cycle. Illustration from the Centers for Disease Control and Prevention (CDC) Web site.
Reinfestation by Aedes aegypti in the Americas after the 1970 (left) mosquito eradication program and most recent distribution as of 2002 (right). Picture from the Centers for Disease Control and Prevention (CDC) Web site.
A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation (DIC), as this severely ill pediatric ICU patient did. Crystalloid fluid resuscitation and standard DIC treatment are critical to the child's survival.
Delayed capillary refill may be the first sign of intravascular volume depletion. Hypotension usually is a late sign in children. This child's capillary refill at 6 seconds was delayed well beyond a normal duration of 2 seconds.
Signs of early coagulopathy may be as subtle as a guaiac test that is positive for occult blood in the stool. This test should be performed on all patients in whom dengue virus infection is suspected.
 
 
 
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