Management of dengue fever in adults

The article is professionally consulted by Master, Doctor Nguyen Thi Nhat - Infectious Disease Specialist - Department of Medical Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.

Dengue fever is caused by the dengue virus. The disease is transmitted from an infected person to a healthy person through the Aedes mosquito. Most of the causes of death from dengue in adults are subjective and confused with symptoms of other diseases.

Dengue fever in adults is transmitted by mosquitoes often with a very sudden onset and rapid progression through 3 stages. The three stages of dengue fever include:
Stage 1: The patient will have a fever in the first 1 or 2 days, sudden high fever, body temperature can reach 39-40 degrees Celsius, very difficult fever, the patient has a severe headache in the forehead. During this stage, the symptoms are often difficult to distinguish from common viral fevers.
Stage 2: This is a very dangerous stage, during this stage, severe symptoms of dengue fever begin to be noticed. This phase usually starts from the 3rd to the 7th day from the time of fever.
At this time, the patient may have had a fever but still have symptoms such as bleeding under the skin, nosebleeds or bleeding gums. Subcutaneous hemorrhages often appear on the front of the legs, the inside of the arms, abdomen, thighs...
These are red spots or a bruised patch depending on the extent. More serious complications, patients may have internal bleeding, pleural or peritoneal effusion, gastrointestinal bleeding or more seriously, brain hemorrhage. At this stage, patients need to be closely monitored and have regular platelet tests.
Stage 3: After the dangerous stage, the patient will enter the recovery phase. At this stage, the patient's fever was gone and his condition started to get better. The patient had an appetite, hemodynamics began to stabilize and the patient urinated a lot, platelet tests gradually increased and returned to normal.

When it is suspected that they have symptoms of dengue fever in adults in particular and have the following signs, the patient needs to be hospitalized for timely treatment to avoid unwanted complications:
The body struggles , lethargy, lethargic Abdominal pain or increased pain in the liver Patient has vomiting >= 3 times/hour or 4 times within 6 hours Urinating less The doctor diagnosed an enlarged liver > 2 cm or elevated liver enzymes ≥ 400 U/l; Mucosal bleeding and Hct increased, platelets rapidly decreased ≤ 100,000/mm3.

3.1 Treatment of dengue fever with warning signs Dengue fever has warning signs when accompanied by symptoms such as moist, cold limbs, the doctor diagnoses capillary filling time ≥ 3 seconds, abdominal pain in the liver , sluggish or struggling, restless; Normal or diastolic blood pressure = 25 mmHg.
Patients will be prescribed intravenous fluids to treat adult dengue fever when they have at least 1 of the following signs:
Lethargy, fatigue Inability to drink water Vomiting a lot of abdominal pain Signs of dehydration Elevated Hct The infusion time is usually no more than 24-48 hours. 3.2. Treatment of dengue shock Patients with dengue shock are usually still awake, if the capillary and vessel filling time is not closely monitored, blood pressure will not be detected early in shock for prompt treatment.
When having dengue shock, the patient will be prescribed intravenous fluids by the doctor. In case of severe dengue shock, the infusion time and volume may be more.
If the patient has stable clinical manifestations, warm limbs, clear pulse, stable blood pressure, clear urine, stable Hematocrit or signs of overload, threatening pulmonary edema, the infusion can be stopped.
Time to stop infusion is usually 24 hours after the shock is gone and the patient shows signs of recovery, usually after 6-7 days.
3.3. Management of hemorrhagic shock associated with hemorrhagic fever If the patient has dengue shock with associated hemorrhagic fever, the treatment of adult dengue fever must be anti-shock with electrolyte solutions (while waiting for red blood cells to settle). Transfusion of erythrocyte sedimentation 5-10ml/kg Correction of coagulopathy Treat hemostasis by: local compression bandages, anterior/posterior nasal insertion, endoscopic interventional hemostasis of the stomach and duodenum,... Review Use a proton pump inhibitor if the patient presents with upper gastrointestinal bleeding or a history of peptic ulcer. Consider vitamin K if the patient presents with severe hepatic impairment. 3.4. Management of cerebral hemorrhagic fever Patients with cerebral haemorrhagic fever often have symptoms of impaired consciousness, convulsions or focal neurological signs. When the patient has the above signs, then:
Prescribe the patient's head to a height of 30 degrees Give the patient an oxygen tank Anti-convulsant treatment (if any) Treat hypoglycemia (if any) Correct electrolyte disturbances - acid-base Cerebral edema: indicated when the patient has clinical signs of increased intracranial pressure: Intubation, mechanical ventilation: increase ventilation to keep PaCO2 30-35 mmHg. Paracetamol 10-15mg/kg/time, 4 times a day if there is fever.

No fever for 2 days, sober; pulse, blood pressure normal; no dyspnea or respiratory distress due to peritoneal or pleural effusion; If the platelet count tends to recover > 50,000/mm3, the patient can be discharged according to the doctor's prescription.

To prevent dengue fever, it is advisable to avoid going outdoors at dawn, dusk and evening, because then there are many mosquitoes outside. When entering mosquito-carrying areas, you should wear a long-sleeve shirt, long pants, socks and shoes, making sure your clothing covers your skin. You should also apply mosquito repellent on areas of your skin that are not covered by clothing, such as your arms, face, legs, and neck. The types of mosquitoes that carry the dengue virus often live in and around homes. They usually live in pools of standing water, such as in pots, drums, or near aquariums. Make sure to clean the aquarium regularly as well as clean up puddles of standing water to not create conditions for mosquitoes to grow. Cover water containers and limit or dispose of items that can contain rainwater (eg old tires, old dishes, pots, etc.). When there is an epidemic, sometimes you have to ask the local government to spray insecticide on a large scale. Master. Doctor. Nguyen Thi Nhat has more than 10 years of experience in the field of artificial kidney, and in the field of infectious diseases, examination and management of patients with kidney disease and infectious diseases. Currently working as a Doctor of Infectious Diseases, Department of General Internal Medicine, Vinmec Hai Phong International General Hospital