Management of Dengue and Chikungunya

Diagnostic Approach

The World Health Organization recommends PCR positive or IgM capture ELISA (if symptoms >5-7 days) for diagnostic confirmation of dengue 1
Nucleic acid amplification tests on serum collected ≤7 days after symptom onset can be used for diagnostic confirmation of dengue 2
For chikungunya, PCR during the first 5 days or IgM against chikungunya from day 6 onwards can be used for diagnostic confirmation 1

The American Society of Tropical Medicine and Hygiene recommends using acetaminophen at standard doses exclusively for pain and fever relief in dengue patients 2
The Centers for Disease Control and Prevention advises against using aspirin and NSAIDs due to increased bleeding risk and platelet dysfunction in dengue patients 2
Ensure adequate oral hydration with oral rehydration solutions for moderate dehydration in non-severe dengue cases 2
Target fluid intake exceeding 2500ml daily for non-severe dengue cases 2, 3
Administer initial fluid bolus of 20 mL/kg with careful reassessment afterward for dengue shock syndrome 2
Consider colloid solutions for severe shock when available in dengue cases 2
Monitor for persistent tissue hypoperfusion; use vasopressors (dopamine or epinephrine) if fluid resuscitation is inadequate in dengue cases 2

Daily complete blood count to track platelet counts and hematocrit levels is recommended 2
Monitor continuously for warning signs: persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding, rising hematocrit with falling platelet count in dengue cases 2, 3
Use continuous cardiac telemetry and pulse oximetry for dengue shock syndrome 2

Acetaminophen remains the safest analgesic option for pregnant women with dengue or chikungunya 2
Acetaminophen dosing must be carefully calculated based on weight for children with dengue or chikungunya 2