Complications
Over-enthusiastic treatment and too rapid hydration can lead to fluid overload, causing pulmonary edema, facial congestion, elevated jugular venous pressure, pleural effusion, or ascites.
These complications should be treated with restriction of intravenous fluid therapy and bolus doses of intravenous furosemide until the patient is stable.
Should be considered in patients with prominent right upper quadrant pain and tenderness, and persistent nausea and vomiting.
Ultrasound is recommended for diagnosis.
Intravenous broad-spectrum antibiotics and conservative management are recommended.[1]
Should be considered in patients with dyspnea and hypoxia.
Chest x-ray shows diffuse shadows.
Management includes assisted ventilation and oxygen therapy.
A rare complication due to the infection causing myonecrosis.
Should be considered in patients with muscle pain.
Diagnostic tests include serum creatine kinase level, electrolytes, and myoglobin levels (blood and urine).[1]
Treatment includes hydration, urine alkalinization, and diuretic therapy.
Some patients may experience post-viral fatigue syndrome for a variable duration of time after infection.[1]
Should be considered in patients with excessive or unusual tiredness, chest discomfort, hypoxia, tachycardia or bradycardia, and ECG changes, including T-wave inversion or bundle-branch blocks.
Troponin T or I estimation and echocardiography should be ordered to assess severity.
Management is supportive. Bed rest is recommended, as well as oxygen therapy. Fluid management should be administered carefully to prevent fluid overload, which may cause heart failure or pulmonary edema.[41] Early treatment with corticosteroids often prevents heart failure and shock.
Invariably, patients with dengue infection have increased liver enzymes suggestive of anicteric hepatitis. In some patients, these levels may rise substantially and the liver may become enlarged and tender.
Liver function tests and coagulation profile should be monitored regularly.
Patients need rest and supportive treatment. Intravenous acetylcysteine may be used. A retrospective analysis of 30 hospitalized adults with severe dengue fever and severe hepatitis found that use of acetylcysteine was associated with faster and significant recovery of liver enzymes.[125]
These patients are at a higher risk of developing dengue hemorrhagic fever. They are also at a high risk of developing severe hepatic necrosis and hepatic encephalopathy.[1][126]
May lead to acute liver failure.
Should be considered in patients presenting with altered level of consciousness, jaundice, and asterixis (liver flap or flapping tremor).
Those with preexisting liver disease are at a higher risk. If liver enzymes increase >10-fold or continue to increase, the risk of developing this complication is high.[1]
Standard management is recommended including fluid restriction. Corticosteroids may be considered to reduce cerebral edema. Plasmapheresis and hemodialysis may be considered if there is clinical deterioration.
Meticulous fluid management to prevent shock and avoidance of hepatotoxic medications help to prevent this complication.[1]
Patient may go on to develop hypoglycemia, bleeding, respiratory distress, electrolyte imbalances, and sepsis.
Should be considered in patients with an altered level of consciousness and convulsions.
Electroencephalogram is a very useful investigation to support the diagnosis and to monitor progression.
Supportive treatments including anticonvulsants are indicated.[1]
Should be considered in patients with prominent gastrointestinal manifestations, including central abdominal pain and vomiting.
Serum amylase level is high and ultrasound examination supports the diagnosis.[1]
Management is conservative.
Should be considered in patients with pain and tenderness in the right iliac fossa and fever.
Very often, patients are admitted to a surgical floor for appendectomy; however, this may be detrimental to the patient due to the high risk of perioperative bleeding.
Patients should be managed conservatively.[1]
Should be considered in patients who develop pancytopenia (usually anemia).[1]
Bone marrow examination is required for confirmation of diagnosis.
Methylprednisolone (pulse dosing) may be used.
Acute disseminated encephalomyelitis (ADEM), Guillain-Barre syndrome, transverse myelitis, and neuropathies may potentially be associated with dengue infection.
The prevalence of ADEM in patients with dengue fever is 0.4%. ADEM is characterized by altered consciousness, seizures, urination problems, visual disturbances, walking problems, ataxia, and slurred speech. It can occur in the acute or post-infectious phases.[128]
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