The guidelines for treating dengue, as per the PAHO/WHO 2022 recommendations, encompass several aspects of patient management:
Severity assessment
- Patients should be assessed for warning signs to identify those at increased risk of progression to severe disease
Setting of care
- Hospitalization should be considered for patients with warning signs, meeting criteria for severe disease, or those with conditions such as oral intolerance, difficulty breathing, narrowing pulse pressure, arterial hypotension, acute renal failure, prolonged capillary refill time, pregnancy, or coagulopathy
Fluid resuscitation
- Intense oral hydration should be initiated in patients with dengue to decrease the progression to severe forms and the appearance of disease complications
- Parenteral hydration should be initiated in patients with at least one warning sign
- Crystalloids should be administered over colloids in the initial management of patients with dengue shock
Antipyretics
- Acetaminophen or metamizole should be considered over NSAIDs, antihistamines, or corticosteroids for the initial symptomatic management of patients with arboviral infection
Corticosteroids and IVIG
- Systemic corticosteroids should be avoided in patients with dengue shock
- Immunoglobulins should be avoided in patients with severe dengue
In conclusion, effective management of dengue involves careful assessment for warning signs, determination of the appropriate setting of care, initiation of appropriate fluid resuscitation, use of recommended antipyretics, and avoidance of interventions that may worsen outcomes, such as corticosteroids and immunoglobulins. Adhering to these guidelines as per the PAHO/WHO 2022 recommendations is essential for optimal patient care and reducing the risk of progression to severe disease.