The treatment of dengue fever primarily focuses on alleviating symptoms, preventing complications, and providing supportive care. Currently, there are no specific antiviral medications that can directly kill the dengue virus, so treatment strategies are mainly centered on symptom management. Patients need to closely monitor vital signs, especially during the critical 24 hours after the fever phase, to reduce the risk of hemorrhagic symptoms or shock.
The treatment goals include maintaining fluid balance, controlling pain and fever, and timely management of severe cases. Mild cases can recover through home care, but if warning signs such as thrombocytopenia or severe abdominal pain occur, immediate hospitalization for professional medical care is necessary. The overall treatment process should be stratified based on the severity of the condition, emphasizing early identification and prompt intervention.
Clinical treatment is primarily based on supportive therapy, which includes fluid replacement, fever reduction, and pain management. Patients with mild symptoms are usually advised to take oral rehydration, while those with severe dehydration or bleeding tendencies require intravenous fluids. The medical team will monitor platelet counts and liver and kidney function through blood tests and assess for signs of internal bleeding.
The treatment process is adjusted in phases: during the fever phase, antipyretics are used to control body temperature, and as the patient transitions to the shock phase, fluid resuscitation should be intensified. Severe patients may need platelet or plasma transfusions, but the risk of bleeding and coagulation status must be strictly evaluated. Treatment plans should be individualized based on the patient's age, underlying conditions, and severity of symptoms.
Paracetamol is the first-line antipyretic, with each dose needing to be controlled within a safe range to avoid liver burden. The use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) is strictly prohibited, as they may exacerbate bleeding tendencies. Medication use should be accompanied by temperature monitoring to prevent excessive cooling that could lead to collapse.
For pain management, physical cooling methods such as cold compresses can be combined to reduce reliance on medications. Physicians will adjust medication dosages based on the patient's liver and kidney function, especially for those with a history of chronic illness.
Currently, there are no FDA-approved antiviral medications, but several new drugs are in clinical trial phases. For example, Favipiravir has shown potential to inhibit viral replication in laboratory tests, but clinical efficacy still requires more data support. Other research directions include interferon inducers and monoclonal antibody therapies, most of which are still in Phase III clinical trials.
Oral rehydration salts (ORS) are the basic therapy, and small sips every hour can effectively prevent dehydration. Patients with severe dehydration need intravenous fluids containing glucose and electrolytes, but hypertonic fluids should be avoided to prevent exacerbating tissue leakage. Daily fluid intake should be adjusted dynamically based on weight and urine output.
For nutritional support, it is recommended to consume small, frequent meals with high-potassium foods such as bananas and coconut water to replenish electrolytes lost due to fever. High-sugar beverages or caffeinated drinks should be avoided, as they may worsen gastrointestinal discomfort.
During the acute phase, complete bed rest is required to avoid excessive activity that may raise body temperature. In the recovery phase, activity levels can gradually increase, but vigorous exercise should be avoided for at least two weeks. Physical therapists may design light rehabilitation exercises to help alleviate muscle soreness.
In terms of environmental adjustments, the patient's room should be well-ventilated and equipped with mosquito nets to prevent reinfection with other vector-borne diseases. Family members should enhance mosquito prevention measures, such as using repellents and eliminating standing water containers.
The BRAT diet (bananas, rice, applesauce, toast) is recommended to alleviate gastrointestinal discomfort. In advanced stages, easily digestible protein sources such as eggs and tofu can be gradually introduced. Dairy products and high-fiber foods should be avoided, as they may exacerbate vomiting.
The dengue vaccine Dengvaxia has been approved for use in certain regions, but it must be administered cautiously due to the antibody-dependent enhancement (ADE) mechanism. New-generation vaccines such as TAK-003, which utilize a tetravalent virus mix design, are undergoing long-term follow-up studies in multiple countries, aiming to enhance cross-serotype protection.
Small molecule inhibitors like TMB-855 are in Phase III clinical trials, acting to block the NS2B-3 protease required for viral replication. Gene therapy approaches are focusing on interfering with viral RNA replication mechanisms, with BCX4430 showing efficacy in reducing viral load in animal studies.
If the following warning signs occur, immediate medical attention is required:
If a patient experiences a recurrence of fever after it has subsided, or if blood pressure remains low, immediate referral to an intensive care unit is necessary. Physicians will assess the bleeding tendency index based on WHO diagnostic criteria and may perform plasma volume expansion therapy if needed.
If symptoms do not improve within 72 hours during home care, a re-evaluation is necessary. Pregnant women and patients over 65 years old require stricter monitoring, as their immune responses may differ from those of the general adult population.
If the patient experiences severe abdominal pain, persistent vomiting, rapid breathing, cold extremities with pale skin, or significantly reduced urine output, it may indicate progression to dengue hemorrhagic fever or shock symptoms, necessitating immediate medical attention. Additionally, confusion or agitation also constitutes an emergency situation that requires prompt medical observation.
Which pain relievers are safe during dengue infection?Aspirin, ibuprofen, and other NSAIDs should be avoided as they may increase bleeding risk. Paracetamol can be chosen to relieve headaches or muscle pain, but dosage instructions must be followed. Any medication should be consulted with a physician before use.
What is the effectiveness of community-wide cleaning in preventing the spread of dengue?Eliminating standing water containers effectively reduces the breeding environment for Aedes mosquitoes. If community groups collaborate regularly on cleaning, mosquito density can be significantly reduced. This, combined with outdoor spraying and public health education, has been proven to significantly lower the likelihood of outbreaks, making it an important part of comprehensive prevention strategies.
How long after recovering from dengue can one resume normal exercise?It is recommended to rest for at least 1 to 2 weeks after recovery, and gradually resume light activities once fatigue subsides and platelet counts return to normal. Vigorous exercise may trigger a risk of secondary bleeding until the physician confirms that physical functions have fully recovered.
Does having had dengue provide immunity against other virus serotypes?Dengue has four serotypes, and immunity is only conferred against the serotype that caused the initial infection; other serotypes can still cause infection. If reinfection occurs with a different serotype, it may even increase the risk of severe disease. Therefore, individuals who have had dengue must continue to take strict mosquito prevention measures and not let their guard down.
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