Management of Dengue and Dengue Haemorrhagic Fever

1. DENGUE FEVER
The management of dengue fever (DF) is symptomatic and supportive.

• Bed rest is advisable during the acute febrile phase.
  
• Antipyretics or sponging are required to keep the body temperature below 40o C. Aspirin should be avoided, particularly in areas where dengue haemorrhagic fever (DHF) is endemic, since it may cause gastritis, bleeding and acidosis.
  
• Analgesics or mild sedatives may be required for those with severe pain.
  
• Oral fluid and electrolyte therapy is recommended for patients with dengue syndrome should be monitored until they become afebrile and platelet counts and hematocrit determinations are normal.
  

2. DENGUE HAEMORRHAGIC FEVER

2.1 General Considerations

00000000 The major pathophysiological abnormality seen in dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) is an acute increase in vascular permeability that leads to leakage of plasma and subsequently to hypovolaemic shock if the loss of plasma is critical. Plasma volume studies reveal a reduction of more than 20 per cent in severe cases(1). Supportive evidence for plasma leakage includes: serous effusion, ascites, haemoconcentration and hypoproteinaemia. In severe cases, the onset of shock is acute, haematocrit readings rise sharply and plasma escapes through the endothelium. Hypovolaemic shock leads to tissue anoxia, metabolic acidosis and death if uncorrected. The acute onset of shock and the rapid, often dramatic, recovery when properly treated together with the fact that no destructive or inflammatory vascular lesions are observed and that there are no sequelae, suggest transient functional, vascular permeability changes that may be due to short acting pharmacological mediators. C3a and C5a anaphylatoxins, cleavage products of complement activation, are elevated around the time of leakage, which indicates an active role of these anaphylatoxins in the pathogenesis of increased vascular permeability(2).