This article discusses current dengue fever treatment guidelines, its shortcomings, as well as alternative treatments and new developments in the management.
INTRODUCTION
Dengue has been wreaking havoc in the tropics, affecting people of all ages, with pediatric population accounting for more than half the prevalence in endemic regions.[1]
CURRENT GUIDELINES
"Patients with co-morbidities like pulmonary disorders, ischemic heart disease, and renal disease/failure rapidly worsen into dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and with unavailability of specific approved treatments targeting Flavivirus , they are left at the mercy of antipyretics and fluid management."
The treatment, for dengue fever (dengue without warning signs), focuses on maintaining hydration, controlling fever and strict monitoring of platelets for early intervention in preventing progress to dengue hemorrhagic fever and dengue shock syndrome.[2]
Development of dengue warning signs mandate intensive care through aggressive fluid resuscitation and compensating for third space fluid loss and platelet transfusions for thrombocytopenia.[2]
Patients with co-morbidities like pulmonary disorders, ischemic heart disease, and renal disease/failure rapidly worsen into dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and with unavailability of specific approved treatments targeting Flavivirus , they are left at the mercy of antipyretics and fluid management.[3,13]
PROBLEMS WITH CURRENT GUIDELINES
Despite aggressive mosquito control and the preventive measures by the government, every year, close to 5 million people get infected with dengue and ∼500,000 individuals require critical care due to dengue hemorrhagic fever, in Southeast Asia, the Pacific and the Americas.[4]
ALTERNATIVE METHODS
"Patients with Severe Refractory Thrombocytopenia in Secondary Dengue have responded to Intravenous Immunoglobulins, leading to mortality reduction."
LEAF EXTRACT
Carica Papaya Leaf extract is a popular folk medication for Dengue fever and its miraculous improvement in platelet counts has been demonstrated by various trials. No known toxicities have been recorded and there is a lack of evidence on optimal dosing, effectiveness in DSS and mortality.[5] Also found to be safe and effective in pediatric population, the lack of concrete evidence has rendered its from addition into national guidelines.[6] Despite aggressive mosquito control and the preventive measures by the government, every year, close to 5 million people get infected with dengue and ∼500,000 individuals require critical care due to dengue hemorrhagic fever, in Southeast Asia, the Pacific and the Americas. Andrographis paniculata extracts and other Siddha Medicines have shown anti-flaviviral activity in vitro and need extensive trials to establish their clinical significance.[8] Crab juice and Oral Isotonic fluids have interestingly been used in Malaysia and needs further evidence.[9]
VITAMINS AND ANTI-OXIDANTS
Calcium and Vitamin D Supplements have shown to decrease viral infectivity at cellular level and a decrease in Antibody dependent enhancement through its inhibition of proinflammatory cytokines while Vitamin E is believed to minimize thrombocytopenia.[10]
Zinc deficiency is associated with increased severity in pediatric cases.[11]
Patients with Severe Refractory Thrombocytopenia in Secondary Dengue have responded to Intravenous Immunoglobulins, leading to mortality reduction.[12]
REFERENCES
Author: Dr. Kajal Patel
Editor: Dr. Tejaswini Ashok