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ImmunityInfection with one serotype provides life long homologous immunity but does not provide protection against other serotypes, and instead may exacerbate subsequent infection.
Important Instructions for Treatment of Dengue hemorrhagic Fever
- Cases of DHF should be observed every hour.
- Serial platelet and haematocrit determinations, drop in platelets and rise in haematocrits are essential for early diagnosis of DHF.
- Timely intravenous therapy – isotonic crystalloid solution can prevent shock and / or lessen its severity.
- If the patient’s condition becomes worse despite giving 20 ml / Kg / hr for one hour, replace crystalloid solution with colloid solution such as dextran or plasma. As soon as improvement occurs replace with crystalloid.
- If improvement occurs, reduce the speed from 20 ml to 10 ml then to 6 ml, and finally to 3 ml / kg.
- If haematocrit falls, give blood transfusion 10 ml / kg and then give crystalloid IV fluids at the rate of 10 ml / kg / hr.
- In case of severe bleeding, give fresh blood transfusion about 20 ml / kg for 2 hours. Then give crystalloid at 10 ml / kg for a short time (30–60 min) & later reduce the speed.
- In case of shock, give oxygen.
- For correction of acidosis (sign: deep breathing), use sodium bi carbonate. (One third of the total fluids should consist of 0.167 mol / litre of sodium bicarbonate i.e. three quarters of crystalloid solution plus glucose plus one quarter sodium bicarbonate).
- For more details on management of DHF / DSS cases, the physician is advised to consult other appropriate references on their treatment. A list of references is given as under:
- Suchitra Nimmannitya, “Clinical Manifestation of DF / DHF” is WHO Regional Publication No. 22–monograph of Dengue / DHF – pp 48 n–n 54, WHO / SEARO, New Delhi.
- Suchitra Nimmannitya, “Management of DF / DHF” is WHO Regional Publication No. 22 – monograph of Dengue / DHF – pp 55–61, WHO / SEARO, New Delhi.
- Suchitra Nimmannitya, Dengue Haemorrhagic Fever diagnosis and management, pp 133–145, in “Dengue and Dengue Haemorrhagic Fever” edited by D. J. Gubler and G. Kuno, Published by CAB International, 1997.
- “Dengue Haemorrohagic fever – diagnosis, treatment, prevention and control” 2nd Edition, WHO, Geneva, 1997.
- “Regional Guidelines for Prevention and Control of Dengue / DHF”, WHO / SEARO, New Delhi, 1998.
- What not to do
- Do not give Aspirin or Brufen for treatment of fever.
- Avoid giving intravenous therapy before there is evidence of haemorrhage and bleeding.
- Avoid giving blood transfusion unless indicated, reduction in haematocrit or severe bleeding.
- Avoid giving steroids. They do not show any benefit.
- Do not use antibiotics.
- Do not change the speed of fluid rapidly, i.e. avoid rapidly increasing or rapidly slowing the speed of fluids.
- Insertion of Nasogastric Tube to determine concealed bleeding or to stop bleeding (by cold lavage) is not recommended since it is hazardous.
- Stable pulse, blood pressure & breathing rate.
- Normal temperature.
- No evidence of external or internal bleeding.
- Return of appetite.
- No vomitting.
- Good Urinary output.
- Stable haematocrit.
- Convalescent confluent petechiae rash.
- Absence of fever for at least 24 hours without the use of anti fever therapy.
- Return of appetite.
- Visible Clinical improvement.
- Good Urine Output.
- Minimum of three days after recovery from shock.
- No respiratory distress from pleural effussion and no ascites.
- Platelet count of more than 50,000 mm3
