Treating the Patient With Severe Dengue Infection

Dengue has been called the most important mosquito-transmitted viral disease in terms of morbidity and mortality. Dengue fever is a benign, acute febrile syndrome occurring in tropical regions. In a small proportion of cases, the virus causes increased vascular permeability that leads to a bleeding diathesis or disseminated intravascular coagulation (DIC) known as dengue hemorrhagic fever (DHF). Secondary infection by a different dengue virus serotype has been confirmed as an important risk factor for the development of DHF.
In 20-30% of DHF cases, the patient develops shock, known as the dengue shock syndrome (DSS).
Worldwide, children younger than 15 years make up 90% of DHF cases.^[1] In the Americas, however, DHF occurs in adults and children.
Dengue fever is not contagious through person-to-person contact.

Complications

Complications are rare but may include the following:

• Brain damage from prolonged shock or intracranial hemorrhage
• Myocarditis
• Encephalopathy
• Liver failure

  Prehospital Care

  Initiate supportive therapy as follows:
  

  • Intravenous (IV) crystalloids, as needed to keep systolic blood pressure above 90 mm Hg
  • Oxygen, empirically