Dengue Treatment & Management

20/11/13 14:55

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Dengue Treatment & Management

Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Burke A Cunha, MD more... Updated: Jul 18, 2013

Approach Considerations
Dengue fever is usually a self-limited illness. There is no specific antiviral treatment currently available for dengue fever. The World Health Organization (WHO) has provided a number of free publications about dengue. Supportive care with analgesics, fluid replacement, and bed rest is usually sufficient. Acetaminophen may be used to treat fever and relieve other symptoms. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided. Management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Single-dose methylprednisolone showed no mortality benefit in the treatment of dengue shock syndrome in a prospective, randomized, double-blind, placebo-controlled trial.[61] The Novartis Institute for Tropical Diseases (NITD) in Singapore is carrying out research to find inhibitors of dengue viral target proteins to reduce the viral load during active infection.[62]

Suspected Dengue
Oral rehydration therapy is recommended for patients with moderate dehydration caused by high fever and vomiting. Patients with known or suspected dengue fever should have their platelet count and hematocrit measured daily from the third day of illness until 1-2 days after defervescence. Patients with clinical signs of dehydration and patients with a rising hematocrit level or falling platelet count should have intravascular volume deficits replaced under close observation. Those who improve can continue to be monitored in an outpatient setting, and those who do not improve should be admitted to the hospital for continued hydration. Patients who develop signs of dengue hemorrhagic fever warrant closer observation. Admission for intravenous fluid administration is indicated for patients who develop signs of dehydration, such as the following: Tachycardia Prolonged capillary refill time Cool or mottled skin Diminished pulse amplitude Altered mental status Decreased urine output Rising hematocrit Narrowed pulse pressure Hypotension

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Severe Dengue
Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Admission to an intensive care unit is indicated for patients with dengue shock syndrome. Patients may need a central intravenous line for volume replacement and an arterial line for accurate blood pressure monitoring and frequent blood tests. Exercise caution when placing intravascular catheters because of the increased bleeding complications of dengue hemorrhagic fever. Urethral catheterization may be useful to strictly monitor urine output. Intravascular volume deficits should be corrected with isotonic fluids such as Ringer lactate solution. Boluses of 10-20 mL/kg should be given over 20 minutes and may be repeated. If this fails to correct the deficit, the hematocrit value should be determined. If it is rising, limited clinical information suggests that a plasma expander may be administered. Starch, dextran 40, or albumin 5% at a dose of 10-20 mL/kg may be used. One study has suggested that starch may be preferable because of hypersensitivity reactions to dextran.[63] If the patient does not improve after infusion of a plasma expander, blood loss should be considered. Patients with internal or gastrointestinal bleeding may require transfusion, and patients with coagulopathy may require fresh frozen plasma. After patients with dehydration are stabilized, they usually require intravenous fluids for no more than 24-48 hours. Intravenous fluids should be stopped when the hematocrit falls below 40% and adequate intravascular volume is present. At this time, patients reabsorb extravasated fluid and are at risk for volume overload if intravenous fluids are continued. Do not interpret a falling hematocrit value in a clinically improving patient as a sign of internal bleeding. Platelet and fresh frozen plasma transfusions may be required to control severe bleeding. A case report demonstrated good improvement following intravenous anti-D globulin administration in 2 patients. The authors proposed that, as in immune thrombocytopenic purpura from disorders other than dengue, intravenous anti-D produces Fc! receptor blockade to raise platelet counts.[64] Patients who are resuscitated from shock rapidly recover. Patients with dengue hemorrhagic fever or dengue shock syndrome may be discharged from the hospital when they meet the following criteria: Afebrile for 24 hours without antipyretics Good appetite, clinically improved condition Adequate urine output Stable hematocrit level At least 48 hours since recovery from shock No respiratory distress Platelet count greater than 50,000 cells/L

Pregnant patients
Dengue in pregnancy must be carefully differentiated from preeclampsia. An overlap of signs and symptoms, including thrombocytopenia, capillary leak, impaired liver function, ascites, and decreased urine output may make this clinically challenging. Pregnant women with dengue fever respond well to the usual therapy of fluids, rest, and antipyretics. However, 3 cases of maternal death due to dengue fever in the third trimester have been reported. An awareness of the clinical and laboratory manifestations of dengue in pregnancy should allow its early recognition and the institution of appropriate treatment. If the mother acquires infection in the peripartum period, newborns should be evaluated for dengue with serial platelet counts and serological studies.[65, 66]

Diet and Activity

No specific diet is necessary for patients with dengue fever. Patients who are able to tolerate oral fluids should be encouraged to drink oral rehydration solution, fruit juice, or water to prevent dehydration from fever, lack of oral intake, or vomiting. Return of appetite after dengue hemorrhagic fever or dengue shock syndrome is a sign of
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recovery. Bed rest is recommended for patients with symptomatic dengue fever, dengue hemorrhagic fever, or dengue shock syndrome. Permit the patient to gradually resume their previous activities, especially during the long period of convalescence.

Prevention
The only way to prevent dengue virus acquisition is to avoid being bitten by a vector mosquito. Although this can be accomplished by avoiding travel to areas where dengue is endemic, that is not an ideal strategy because it would require a person to avoid most tropical and subtropical regions of the world, many of which are popular travel and work destinations. Other measures are as follows: Wear N,N-diethyl-3-methylbenzamide (DEET)containing mosquito repellant Wear protective clothing, preferably impregnated with permethrin insecticide Remain in well-screened or air-conditioned places The use of mosquito netting is of limited benefit, as Aedes are day-biting mosquitoes Eliminate the mosquito vector using indoor sprays The most widely used mosquito-control technique, spraying cities to kill adult mosquitoes, is not effective. Efforts should target the larval phase with larvicides and cleaning up larvae habitats. Poor sanitation and poor refuse control provide excellent conditions for mosquito larvae to grow. Hurricanes and other natural disasters increase the habitat for mosquito growth in urban areas by increasing rubble and garbage, which act as water reservoirs. Breeding of vector mosquitoes can be reduced by eliminating small accumulations of stagnant water around human habitats (eg, disposing of old tires, covering water receptacles, and changing water in birdbaths daily. Support community-based vector control programs (including source reduction) and the use of vectoricidal agents, including predatory copepods as biological control agents.[67, 68, 69, 70] Outbreaks of dengue will increasingly cross common borders of endemic and disease-free countries unless the following measures are undertaken: Increased health surveillance Prompt reporting of new cases Heightened professional awareness Public education

Vaccine Development
No vaccine is currently approved for the prevention of dengue infection. Because immunity to a single dengue strain is the major risk factor for dengue hemorrhagic fever and dengue shock syndrome, a vaccine must provide high levels of immunity to all 4 dengue strains to be clinically useful.[71] Immunogenic, safe tetravalent vaccines have been developed and are undergoing clinical trials.[72] Candidate vaccines include a live-attenuated virus, recombinant envelope proteins, and an inactivated virus.[73, 74, 75] The estimates of the time needed for further testing of candidate vaccines range from 5-10 years. Sanofi Pasteur has reported successful results of phase II trials of its tetravalent recombinant live attenuated vaccine.[76, 77] Registration is anticipated in 2012.

Consultations
Consultation with an infectious diseases specialist may be helpful in guiding decisions regarding diagnosis and treatment. Consultation with a critical care medicine specialist may be helpful when treating patients with dengue hemorrhagic fever or dengue shock syndrome and severe hemorrhagic manifestations or shock. Telephone consultation may be obtained from the Centers for Disease Control and Surveillance (800-232-4636,
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8am-8pm ET/Monday-Friday).

Contributor Information and Disclosures

Author Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Professor of Emergency Medicine, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine; Medical Director, Fast Track, Department of Emergency Medicine Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society Disclosure: Nothing to disclose. Coauthor(s) Patrick B Hinfey, MD Emergency Medicine Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine Patrick B Hinfey, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Society for Academic Emergency Medicine, and Wilderness Medical Society Disclosure: Nothing to disclose. William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society Disclosure: Nothing to disclose. Chief Editor Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America Disclosure: Nothing to disclose. Additional Contributors Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa Disclosure: Nothing to disclose. Hagop A Isnar, MD, FACEP Department of Emergency Medicine, Crouse Hospital Hagop A Isnar, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
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Disclosure: Nothing to disclose. Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society Disclosure: Nothing to disclose. Deborah Sentochnik, MD Consulting Staff, Department of Internal Medicine, Division of Infectious Disease, The Mary Imogene Bassett Hospital Deborah Sentochnik, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Medical Society of the State of New York Disclosure: Nothing to disclose. Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Reference Salary Employment Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose.

References
1. Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol. 2008;62:71-92. [Medline]. 2. Statler J, Mammen M, Lyons A, Sun W. Sonographic findings of healthy volunteers infected with dengue virus. J Clin Ultrasound. Sep 2008;36(7):413-7. [Medline]. 3. Gubler DJ. Cities spawn epidemic dengue viruses. Nat Med. Feb 2004;10(2):129-30. [Medline]. 4. Wilder-Smith A, Gubler DJ. Geographic expansion of dengue: the impact of international travel. Med Clin North Am. Nov 2008;92(6):1377-90, x. [Medline]. 5. Halstead SB. Dengue. Lancet. Nov 10 2007;370(9599):1644-52. [Medline]. 6. Chowell G, Torre CA, Munayco-Escate C, Surez-Ognio L, Lpez-Cruz R, Hyman JM. Spatial and temporal dynamics of dengue fever in Peru: 1994-2006. Epidemiol Infect. Dec 2008;136(12):1667-77. [Medline]. 7. Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F. Spectrum of disease and
http://emedicine.medscape.com/article/215840-treatment#aw2aab6b6b3 Pgina 5 de 9

Dengue Treatment & Management

20/11/13 14:55

relation to place of exposure among ill returned travelers. N Engl J Med. Jan 12 2006;354(2):119-30. [Medline]. 8. CDC. Imported dengue--United States, 1997 and 1998. MMWR Morb Mortal Wkly Rep. Mar 31 2000;49(12):248-53. [Medline]. [Full Text]. 9. Engelthaler DM, Fink TM, Levy CE, Leslie MJ. The reemergence of Aedes aegypti in Arizona. Emerg Infect Dis. Apr-Jun 1997;3(2):241-2. [Medline]. [Full Text]. 10. Chye JK, Lim CT, Ng KB, et al. Vertical transmission of dengue. Clin Infect Dis. Dec 1997;25(6):1374-7. [Medline]. 11. Wagner D, de With K, Huzly D, Hufert F, Weidmann M, Breisinger S, et al. Nosocomial acquisition of dengue. Emerg Infect Dis. Oct 2004;10(10):1872-3. [Medline]. 12. Dejnirattisai W, Duangchinda T, Lin CL, Vasanawathana S, Jones M, Jacobs M, et al. A complex interplay among virus, dendritic cells, T cells, and cytokines in dengue virus infections. J Immunol. Nov 1 2008;181(9):5865-74. [Medline]. 13. Halstead SB, Heinz FX, Barrett AD, Roehrig JT. Dengue virus: molecular basis of cell entry and pathogenesis, 25-27 June 2003, Vienna, Austria. Vaccine. Jan 4 2005;23(7):849-56. [Medline]. 14. Limjindaporn T, Wongwiwat W, Noisakran S, Srisawat C, Netsawang J, Puttikhunt C, et al. Interaction of dengue virus envelope protein with endoplasmic reticulum-resident chaperones facilitates dengue virus production. Biochem Biophys Res Commun. Feb 6 2009;379(2):196-200. [Medline]. 15. Zhang JL, Wang JL, Gao N, Chen ZT, Tian YP, An J. Up-regulated expression of beta3 integrin induced by dengue virus serotype 2 infection associated with virus entry into human dermal microvascular endothelial cells. Biochem Biophys Res Commun. May 11 2007;356(3):763-8. [Medline]. 16. Rothman AL, Ennis FA. Immunopathogenesis of Dengue hemorrhagic fever. Virology. Apr 25 1999;257(1):1-6. [Medline]. 17. Chen LC, Lei HY, Liu CC, Shiesh SC, Chen SH, Liu HS. Correlation of serum levels of macrophage migration inhibitory factor with disease severity and clinical outcome in dengue patients. Am J Trop Med Hyg. Jan 2006;74(1):142-7. [Medline]. 18. Green S, Rothman A. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis. Oct 2006;19(5):429-36. [Medline]. 19. Guzman MG, Alvarez M, Rodriguez-Roche R, Bernardo L, Montes T, Vazquez S. Neutralizing antibodies after infection with dengue 1 virus. Emerg Infect Dis. Feb 2007;13(2):282-6. [Medline]. 20. Restrepo BN, Ramirez RE, Arboleda M, Alvarez G, Ospina M, Diaz FJ. Serum levels of cytokines in two ethnic groups with dengue virus infection. Am J Trop Med Hyg. Nov 2008;79(5):673-7. [Medline]. 21. Rothman AL. Dengue: defining protective versus pathologic immunity. J Clin Invest. Apr 2004;113(7):94651. [Medline]. 22. de Macedo FC, Nicol AF, Cooper LD, Yearsley M, Pires AR, Nuovo GJ. Histologic, viral, and molecular correlates of dengue fever infection of the liver using highly sensitive immunohistochemistry. Diagn Mol Pathol. Dec 2006;15(4):223-8. [Medline]. 23. Shah I. Dengue and liver disease. Scand J Infect Dis. 2008;40(11-12):993-4. [Medline]. 24. Dejnirattisai W, Jumnainsong A, Onsirisakul N, et al. Cross-reacting antibodies enhance dengue virus infection in humans. Science. May 7 2010;328(5979):745-8. [Medline]. 25. Schmidt AC. Response to dengue fever--the good, the bad, and the ugly?. N Engl J Med. Jul 29 2010;363(5):484-7. [Medline].
http://emedicine.medscape.com/article/215840-treatment#aw2aab6b6b3 Pgina 6 de 9

Dengue Treatment & Management

20/11/13 14:55

26. Kurane I, Innis BL, Nimmannitya S, Nisalak A, Meager A, Ennis FA. High levels of interferon alpha in the sera of children with dengue virus infection. Am J Trop Med Hyg. Feb 1993;48(2):222-9. [Medline]. 27. Wang E, Ni H, Xu R, Barrett AD, Watowich SJ, Gubler DJ. Evolutionary relationships of endemic/epidemic and sylvatic dengue viruses. J Virol. Apr 2000;74(7):3227-34. [Medline]. 28. Centers for Disease Control and Prevention Web site. CDC traveler's health page. Dengue. Available at http://www.cdc.gov/Dengue/travelOutbreaks/. Accessed October 20, 2011. 29. Chen WS, Wong CH, Cillekens L. Dengue antibodies in a suburban community in Malaysia. Med J Malaysia. Mar 2003;58(1):142-3. [Medline]. 30. Istriz RE, Gubler DJ, Brea del Castillo J. Dengue and dengue hemorrhagic fever in Latin America and the Caribbean. Infect Dis Clin North Am. Mar 2000;14(1):121-40, ix. [Medline]. 31. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis. Sep 24 2008;2(9):e300. [Medline]. [Full Text]. 32. Centers for Disease Control and Prevention (CDC). Travel-associated Dengue surveillance - United States, 2006-2008. MMWR Morb Mortal Wkly Rep. Jun 18 2010;59(23):715-9. [Medline]. [Full Text]. 33. Centers for Disease Control and Prevention (CDC). Locally acquired Dengue--Key West, Florida, 20092010. MMWR Morb Mortal Wkly Rep. May 21 2010;59(19):577-81. [Medline]. 34. Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infections. Postgrad Med J. Oct 2004;80(948):588-601. [Medline]. [Full Text]. 35. Stephenson JR. Understanding dengue pathogenesis: implications for vaccine design. Bull World Health Organ. Apr 2005;83(4):308-14. [Medline]. [Full Text]. 36. World Health Organization. Impact of Dengue. Available at http://www.who.int/csr/disease/dengue/impact/en/index.html. Accessed October 14, 2011. 37. Lin CC, Huang YH, Shu PY, et al. Characteristic of dengue disease in Taiwan: 2002-2007. Am J Trop Med Hyg. Apr 2010;82(4):731-9. [Medline]. [Full Text]. 38. Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, Libraty DH, Rothman AL. Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study. Lancet. Apr 28 2007;369(9571):1452-9. [Medline]. 39. Lahiri M, Fisher D, Tambyah PA. Dengue mortality: reassessing the risks in transition countries. Trans R Soc Trop Med Hyg. Oct 2008;102(10):1011-6. [Medline]. 40. Beatty ME, Beutels P, Meltzer MI, et al. Health economics of dengue: a systematic literature review and expert panel's assessment. Am J Trop Med Hyg. Mar 2011;84(3):473-88. [Medline]. [Full Text]. 41. Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg. Feb 2011;84(2):200-7. [Medline]. [Full Text]. 42. Suaya JA, Shepard DS, Siqueira JB, et al. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg. May 2009;80(5):846-55. [Medline]. 43. WHO. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd ed. Geneva: World Health Organization; 1997. [Full Text]. 44. Sanjay S, Wagle AM, Au Eong KG. Dengue optic neuropathy. Ophthalmology. Jan 2009;116(1):170; author reply 170. [Medline]. 45. Teves Maria A. Wrong treatment most common cause of dengue fatality. ABS/CBN News. Available at
http://emedicine.medscape.com/article/215840-treatment#aw2aab6b6b3 Pgina 7 de 9

Dengue Treatment & Management

20/11/13 14:55

http://www.abs-cbnnews.com/nation/09/03/09/wrong-treatment-most-common-cause-dengue-fatality. Accessed September 3, 2010. 46. Bottieau E, Clerinx J, Van den Enden E, Van Esbroeck M, Colebunders R, Van Gompel A. Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions. Medicine (Baltimore). Jan 2007;86(1):18-25. [Medline]. 47. Malhotra N, Chanana C, Kumar S. Dengue infection in pregnancy. Int J Gynaecol Obstet. Aug 2006;94(2):131-2. [Medline]. 48. Singh N, Sharma KA, Dadhwal V, Mittal S, Selvi AS. A successful management of dengue fever in pregnancy: report of two cases. Indian J Med Microbiol. Oct-Dec 2008;26(4):377-80. [Medline]. 49. Warrilow D, Northill JA, Pyke A, Smith GA. Single rapid TaqMan fluorogenic probe based PCR assay that detects all four dengue serotypes. J Med Virol. Apr 2002;66(4):524-8. [Medline]. 50. Kong YY, Thay CH, Tin TC, Devi S. Rapid detection, serotyping and quantitation of dengue viruses by TaqMan real-time one-step RT-PCR. J Virol Methods. Dec 2006;138(1-2):123-30. [Medline]. 51. Trung DT, Thao le TT, Hien TT, et al. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg. Oct 2010;83(4):774-80. [Medline]. [Full Text]. 52. Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health. Nov 2008;13(11):1328-40. [Medline]. [Full Text]. 53. Lima EQ, Nogueira ML. Viral hemorrhagic fever-induced acute kidney injury. Semin Nephrol. Jul 2008;28(4):409-15. [Medline]. 54. Lombardi R, Yu L, Younes-Ibrahim M, Schor N, Burdmann EA. Epidemiology of acute kidney injury in Latin America. Semin Nephrol. Jul 2008;28(4):320-9. [Medline]. 55. Chaterji S, Allen JC Jr, Chow A, Leo YS, Ooi EE. Evaluation of the NS1 rapid test and the WHO dengue classification schemes for use as bedside diagnosis of acute dengue fever in adults. Am J Trop Med Hyg. Feb 2011;84(2):224-8. [Medline]. [Full Text]. 56. Wichmann O, Stark K, Shu PY, Niedrig M, Frank C, Huang JH. Clinical features and pitfalls in the laboratory diagnosis of dengue in travellers. BMC Infect Dis. 2006;6:120. [Medline]. 57. Domingo C, de Ory F, Sanz JC, Reyes N, Gascn J, Wichmann O, et al. Molecular and serologic markers of acute dengue infection in naive and flavivirus-vaccinated travelers. Diagn Microbiol Infect Dis. Sep 2009;65(1):42-8. [Medline]. 58. Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J. Apr 2007;26(4):283-90; discussion 291-2. [Medline]. 59. Srikiatkhachorn A, Gibbons RV, Green S, et al. Dengue hemorrhagic fever: the sensitivity and specificity of the world health organization definition for identification of severe cases of dengue in Thailand, 19942005. Clin Infect Dis. Apr 15 2010;50(8):1135-43. [Medline]. [Full Text]. 60. Setiati TE, Mairuhu AT, Koraka P, Supriatna M, Mac Gillavry MR, Brandjes DP, et al. Dengue disease severity in Indonesian children: an evaluation of the World Health Organization classification system. BMC Infect Dis. Mar 26 2007;7:22. [Medline]. [Full Text]. 61. Tassniyom S, Vasanawathana S, Chirawatkul A, Rojanasuphot S. Failure of high-dose methylprednisolone in established dengue shock syndrome: a placebo-controlled, double-blind study. Pediatrics. Jul 1993;92(1):111-5. [Medline]. 62. WHO. Dengue. Available at http://www.who.int/topics/dengue/en/. Accessed October 20, 2011.

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Pgina 8 de 9

Dengue Treatment & Management

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63. Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med. Sep 1 2005;353(9):877-89. [Medline]. 64. Yadav SP, Sachdeva A, Gupta D, Sharma SD, Kharya G. Control of massive bleeding in dengue hemorrhagic fever with severe thrombocytopenia by use of intravenous anti-D globulin. Pediatr Blood Cancer. Dec 2008;51(6):812-3. [Medline]. 65. Waduge R, Malavige GN, Pradeepan M, Wijeyaratne CN, Fernando S, Seneviratne SL. Dengue infections during pregnancy: a case series from Sri Lanka and review of the literature. J Clin Virol. Sep 2006;37(1):27-33. [Medline]. 66. Ismail NA, Kampan N, Mahdy ZA, Jamil MA, Razi ZR. Dengue in pregnancy. Southeast Asian J Trop Med Public Health. Jul 2006;37(4):681-3. [Medline]. 67. Billingsley PF, Foy B, Rasgon JL. Mosquitocidal vaccines: a neglected addition to malaria and dengue control strategies. Trends Parasitol. Sep 2008;24(9):396-400. [Medline]. 68. Erlanger TE, Keiser J, Utzinger J. Effect of dengue vector control interventions on entomological parameters in developing countries: a systematic review and meta-analysis. Med Vet Entomol. Sep 2008;22(3):203-21. [Medline]. 69. Kay B, Vu SN. New strategy against Aedes aegypti in Vietnam. Lancet. Feb 12-18 2005;365(9459):613-7. [Medline]. 70. Hanh TT, Hill PS, Kay BH, Quy TM. Development of a framework for evaluating the sustainability of community-based dengue control projects. Am J Trop Med Hyg. Feb 2009;80(2):312-8. [Medline]. 71. Monath TP. Dengue and yellow fever--challenges for the development and use of vaccines. N Engl J Med. Nov 29 2007;357(22):2222-5. [Medline]. 72. McArthur JH, Durbin AP, Marron JA, Wanionek KA, Thumar B, Pierro DJ, et al. Phase I clinical evaluation of rDEN4Delta30-200,201: a live attenuated dengue 4 vaccine candidate designed for decreased hepatotoxicity. Am J Trop Med Hyg. Nov 2008;79(5):678-84. [Medline]. [Full Text]. 73. O'Brien J. 12th Annual Conference on Vaccine Research. Expert Rev Vaccines. Sep 2009;8(9):1139-42. [Medline]. 74. Edelman R. Dengue vaccines approach the finish line. Clin Infect Dis. Jul 15 2007;45 Suppl 1:S56-60. [Medline]. 75. Blaney JE Jr, Durbin AP, Murphy BR, Whitehead SS. Development of a live attenuated dengue virus vaccine using reverse genetics. Viral Immunol. Spring 2006;19(1):10-32. [Medline]. 76. Sanofi Pasteur and International Vaccine Institute Partner Against Dengue. Available at http://www.dengue.info/front/index.jsp?siteCode=DENGUE. Accessed October 20, 2011. 77. Lang J. Recent progress on sanofi pasteur's dengue vaccine candidate. J Clin Virol. Oct 2009;46 Suppl 2:S20-4. [Medline]. Medscape Reference 2011 WebMD, LLC

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