Dengue is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin 3 to14 days after infection. This may include a high grade fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. Generally diagnosed by dengue non-structural protein type 1 (NS1) detection. Children younger than 15 years usually have a nonspecific febrile syndrome, which may be accompanied by a maculopapular rash.
Medications:
- Tab. Calpol 650 (Paracetamol 650 mg) 1 tablet thrice a day.
- Tab. Avomine 25 (Promethazine 25 mg) 1 tablet thrice a day for nausea.
- Tab. Caripill (Carica papaya leaf extract 1100 mg) 1 tablet thrice a day for 5 days. For children – 275 mg tablet, thrice a day for 5 days.
- For diarrhoea – Cap. Roko (Loperamide 2 mg) – 2 capsules after first loose stool, then 1 capsule after each loose stool (maximum dose – 16 mg per day).
Emperical treatment (for missed diagnoses and typhoid)-
- Cap. Microdox-LBS (Doxycycline 100 mg, Lactobacillus-5 billion spores) 1 capsule twice a day on day 1 and then 100 mg once a day for 5 days. Avoid in cases of colitis or liver dysfunction.
- Tab. Azee 1000 (Azithromycin 1000 mg) 1 tablet on day 1 and then 500 mg tablet from day 2 to 7. Avoid in cases of QTc prolongation, colitis and liver dysfunction suspected.
General advice:
- Tepid sponging of whole body to reduce fever.
- Ensure adequate hydration. Refer to rehydration guidelines.
- Advice bed rest during acute phase.
- Ensure cleanliness around house as recommended by public health of India.
Investigations:
- Daily complete blood count – for monitoring of hematocrit and platelet count.
- NS1 Dengue antigen test – will be positive in first 7 days of infection.
- MAC ELIZA IgM assay for dengue – will be positive from 7th day till 12th week of infection.
- Renal and liver function test – this can be deranged in multi-organ failure.
Indications for hospitalisation
- Infants, elderly and pregnant women
- Serious comorbidities (diabetes mellitus, unreliable social situation)
- Findings suggestive of impending severe dengue
Referral:
Refer to tertiary care unit in case of complications. Advice from infectious disease specialist can be sought in unclear diagnosis.