How to Care for Dengue Fever Patients

Dengue fever is a viral illness transmitted by Aedes mosquitoes. It is common in Southeast Asia, the Western Pacific, Central America, South America, and Africa. Living in or traveling to these areas, especially rural regions, can increase the risk of contracting Dengue. Patients with Dengue fever typically experience symptoms such as severe headaches, skin rashes, joint pain, and high fever. There are several ways to care for and treat patients with Dengue fever.

Recognizing the Incubation Period. It typically takes about a week for symptoms to appear in an infected person. The symptoms help determine the severity of the disease and guide the treatment plan.

• After being bitten by a mosquito carrying the Dengue virus, symptoms usually appear within 4-7 days. These symptoms generally last for about 3-10 days.

Monitor for warning signs of severe Dengue symptoms. There are two types of Dengue fever: with warning signs and without warning signs.

• Dengue fever without warning signs is typically identified by the fever (around 40°C) and at least two (or more) of the following symptoms: nausea or vomiting; a rash causing redness on the face, arms, legs, chest, and back; body aches; low white blood cell count; swelling of lymph nodes in the neck and behind the ears.
• Dengue fever with warning signs is similar to the non-warning type, but the patient will exhibit one (or more) of the following: abdominal pain; continuous vomiting; fluid accumulation in the abdomen and lungs; bleeding from gums, eyes, or nose; lethargy or restlessness; enlarged liver.
• The warning signs indicate that Dengue fever could have become severe, leading to hemorrhaging or organ failure, or even progressing into Dengue Hemorrhagic Fever (DHF). If any of these symptoms appear and the patient is not brought to a hospital, they may die within 24-48 hours.

Determine if the patient is experiencing severe Dengue fever. Severe Dengue fever includes the symptoms listed above, along with one of the following:

• Severe bleeding or blood in the urine
• Severe fluid retention in the abdomen or lungs
• Loss of consciousness
• Impact on other organs like the heart, causing severe fluid retention, low blood pressure, and rapid heart rate.
• If any of these symptoms occur, bring the patient to the nearest hospital immediately.

Go to the hospital. All patients with severe Dengue fever or those showing warning signs should be taken to the hospital as soon as possible. Even patients with Dengue fever without warning signs should visit a hospital for a thorough check-up and confirmation of the diagnosis.

Determine the treatment and care plan for the patient. Dengue fever treatment can be carried out at home or in a hospital. For severe cases or those with warning signs, patients should be treated in a hospital.

• Home care should only be done if the patient: 1) has no warning signs; 2) is able to consume adequate fluids orally; 3) can urinate at least once every 6 hours.
• It is important to note that there is currently no specific medication or treatment for Dengue fever. The primary focus of treatment is on managing the symptoms of Dengue fever.

Maintain a clean environment and keep mosquitoes away. While caring for a Dengue fever patient at home, it's crucial to avoid mosquito bites since the disease can spread from person to person via mosquito bites. In other words, mosquito control is an essential step in preventing the transmission of the illness.

• Close windows and doors to prevent mosquitoes from entering the house.
• Use a mosquito net while sleeping.
• Wear clothing that minimizes skin exposure to mosquitoes.
• Apply mosquito repellent on exposed skin. Mosquito repellents containing DEET, picaridin, and eucalyptus oil are highly effective. However, be cautious when applying repellent to young children. Adults should apply repellent to their hands first and then use it on the child’s skin. Do not use mosquito repellent for children under 2 months old.
• Eliminate stagnant water around the house and regularly clean water storage containers to prevent mosquito breeding.

Take the Dengue patient to the hospital daily. The patient needs to visit the hospital each day for monitoring the fever and white blood cell count. The patient should seek medical attention immediately if the fever exceeds 37.5°C. The hospital monitoring can end when the patient has been fever-free for 48 hours.

Ensure the patient gets adequate rest. Allow the patient to gradually return to normal activities, especially during the recovery period.

• Since Dengue fever often causes fatigue and lethargy, the patient needs rest and should proceed cautiously when resuming daily activities.

Administer Acetaminophen/paracetamol (Tylenol®) to the patient. This medication helps in reducing fever. A 325-500 mg tablet can be given. The patient may take up to 4 tablets per day.

• Do not administer Aspirin, Ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) to the patient. These medications could increase the risk of bleeding in Dengue patients.

Encourage the patient to drink plenty of fluids. The patient should consume water, fruit juices, and other hydrating beverages to prevent dehydration caused by fever or vomiting.

• Drinking enough fluids can reduce the risk of hospitalization for Dengue patients.
• Men and women (ages 19-30) should drink about 3 liters and 2.7 liters of fluids daily, respectively. Young men and women should aim for 2.7 and 2.2 liters daily. Infants should consume 0.7-0.8 liters per day.
• Dengue patients may also drink papaya leaf juice. Some reports suggest that papaya leaf extracts help increase platelet count in Dengue patients, though no clinical studies have confirmed this claim yet.

Document the patient's symptoms daily. Keeping a daily record helps you track if symptoms worsen. It's especially important to monitor newborns and young children closely, as they are at higher risk for severe Dengue fever. Be sure to document the following details:

• Body temperature. Since body temperature can fluctuate throughout the day, it’s best to record the temperature at the same time each day. This method provides more accurate and reliable data.
• Fluid intake. Ask the patient to drink from a separate cup to make it easier to track and record the amount of fluids consumed.
• Urine output. Request the patient to urinate into a bedpan. Measure and record the volume of urine each time. Bedpans are commonly used in hospitals to measure urine over a 24-hour period. Hospitals may provide them, or you can request one.

Take the patient to the hospital if the symptoms worsen. Seek medical help immediately if the patient shows any of the following signs:

• High fever
• Severe abdominal pain
• Persistent vomiting
• Cold, sweaty extremities (could be due to dehydration or blood loss)
• Unresponsiveness
• Confusion (possibly due to dehydration or blood loss)
• Infrequent urination (less than once every 6 hours)
• Bleeding (vaginal, nasal, eye, or gum bleeding, or red or purple spots on the skin)
• Difficulty breathing (due to fluid accumulation in the lungs)

Intravenous fluid therapy. For severe cases of Dengue fever in the hospital, doctors will administer intravenous fluids and electrolytes (salts) to the patient. This method helps replenish fluids lost due to vomiting or diarrhea. Intravenous therapy is only used if the patient is unable to drink fluids (e.g., due to severe vomiting) or is in shock.

• Intravenous means "within a vein." In other words, the fluid is directly administered into one of the patient's veins through an injection or IV catheter.
• The recommended fluid is typically a crystalloid solution (0.9% saline).
• Recent guidelines suggest exercising caution when administering intravenous fluids, and the doctor will monitor the process closely. This is because excessive fluid infusion can cause side effects, including vascular overload or capillary leak. Therefore, in most cases, doctors will administer fluids slowly instead of continuously.

Blood transfusion. In more severe cases of Dengue fever, the doctor may need to perform a blood transfusion to replace lost blood. Blood transfusion is an essential treatment for patients with severe Dengue hemorrhagic fever.

• The transfusion process may involve administering fresh blood or just platelets (a component of blood that helps with clotting and is smaller than red or white blood cells).

Corticosteroid injection. Corticosteroids are synthetic drugs designed to mimic cortisol, a hormone naturally produced by the adrenal glands. These drugs work by reducing inflammation and suppressing immune system activity.

• The effects of corticosteroids on patients with Dengue fever are still being studied through medical trials, and the results have yet to be conclusive.