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.

Dengue vaccine was approved by the FDA in 2019 for individuals aged 9-16 years with laboratory-confirmed previous dengue infection who live in endemic areas.

Class Summary

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

Acetaminophen (Tylenol, Feverall, Acephen, Mapap)

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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.

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)

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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)

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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)

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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.

Class Summary

Elicits dengue-specific immune responses against the 4 dengue virus serotypes (ie, serotypes 1, 2, 3, and 4).

Dengue vaccine (Dengvaxia)

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Indicated for prevention of dengue disease caused by dengue virus serotypes 1, 2, 3, and 4 in individuals aged 9-16 years with laboratory-confirmed previous dengue infection who live in endemic areas. It is approved only in individuals previously infected by any dengue virus serotype or in whom this information is unknown. Persons not previously infected are at an increased risk of severe dengue disease when vaccinated and subsequently infected with dengue virus. Immunization is a series of 3 SC injections administered 6 months apart.

Questions

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Media Gallery

Drawing of Aedes aegypti mosquito. Courtesy of the Centers for Disease Control and Prevention (CDC).
Aedes albopictus. Courtesy of the Centers for Disease Control and Prevention (CDC).
Worldwide distribution of dengue in 2000. Courtesy of the Centers for Disease Control and Prevention (CDC).
Worldwide distribution of dengue in 2003. Courtesy of the Centers for Disease Control and Prevention (CDC).
Worldwide distribution of dengue in 2005. Courtesy of the Centers for Disease Control and Prevention (CDC).
Increasing rates of dengue infection by regions of the world. Courtesy of the World Health Organization (WHO).
Dengue transmission cycle. Courtesy of the Centers for Disease Control and Prevention (CDC).
Reinfestation by Aedes aegypti in the Americas after the 1970 (left) mosquito eradication program and most recent distribution as of 2002 (right). Courtesy of the Centers for Disease Control and Prevention (CDC).
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.
Aedes aegypti mosquito. Courtesy of Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Aedes_aegypti.jpg; author Muhammad Mahdi Karim).
Global map of dengue risk. Frequent or continuous risk = frequent outbreaks or ongoing transmission. Sporadic or uncertain risk = variable and unpredictable risk, country-level data are unavailable. Courtesy of the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html).

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Author

Darvin Scott Smith, MD, MSc, DTM&H, FIDSA Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Permanente Medical Group

Darvin Scott Smith, MD, MSc, DTM&H, FIDSA is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David J Mariano, BS, MS MD Candidate, University of California, San Diego, School of Medicine

Disclosure: Nothing to disclose.

Micah Lynne Trautwein, BS MD Candidate, Geisel School of Medicine at Dartmouth

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; Fellow of the Royal College of Physicians, London

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

Disclosure: Nothing to disclose.

Additional Contributors

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.

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 Former Director, PENN Travel Medicine; Former 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.

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