ELISA= enzyme-linked immunosorbent assay; HIA = haemagglutination inhibition assay; IgG = immunoglobulin G; IgM = immunoglobulin M; NS1 Ag = Non - structural
protein 1 antigen; RT – PCR = reverse transcriptase polymerase chain reaction.
Source: WHO – TDR 2012 10
4. Recommendation for Clinical Management
There is no currently available anti viral medication against the dengue virus after the host invasion. The of dengue infection management stays symptomatic and
supportive. Dengue is a dynamic disease and management issues vary according to the three phases of the clinical course. It is crucial to recognize plasma leakage and
shock at an early stage, to guard against severe organ impairment. This can only be achieved through frequent clinical and laboratory monitoring.
4.1 Clinical Management The stepwise approach for management of dengue can be used to assessing
dengue case investigation Table 3. Figure 4, Figure 5, Figure 6, Figure 7 and and Figure 6 show the summary of management decision.
Table 3. A stepwise approach to the management of dengue Step I
– Overall assessment I.1
History, including symptoms, family history and past medical history
I.2 Physical examination, including full physical and mental asessement
I.3 Investigation, including routine laboratory tests and dengue-specific laboratory
tests
Step II − Diagnosis, assessment of disease phase and severity Based on evaluations from history, physical examination +- CBC and HCT, the
clinicians should be able to determine: 1. Diagnosis of Dengue Fever suspected, probable or confirmed
2. The phase of illness febrilecriticalconvalescent or recovery 3. The hydration and hemodynamic status of patient
4. Whether the patient requires admission Step III
– Management III.1 Disease notification
III.2 Management decisions. Depending on the clinical manifestations and other
circumstances, patients may: - be sent home Group A
- be referred for in-hospital management Group B - require emergency treatment and urgent referral Group C
Figure 4. Assessment of the patients
Figure 5. Group A Outpatient management
Figure 6. Group B Inpatient management for dengue patients with warning signs
Figure 7. Group C Emergency management for dengue patients with compensated shock
Figure 8. Group C Emergency management for dengue patients with Hypotensive shock
