Fluid management and outcomes of dengue fever in Japan: single-center descriptive study in a non-endemic country

BACKGROUND: Dengue fever (DF) is endemic in tropical and subtropical regions. Nonetheless, sporadic cases of autochthonous dengue have also been reported in non-endemic countries. Although preparedness for dengue outbreaks in these settings is essential, evidence describing clinical presentation of patients and fluid management remains limited. This single-center retrospective descriptive study was conducted to examine the clinical management of DF in Japan, with a particular focus on fluid management. METHODS: This study included patients diagnosed with DF from January 1, 2013, to December 31, 2020. The inclusion criterion was a body temperature of ≥ 37.0 °C. Epidemiological, demographic, and clinically relevant data were obtained through data extraction and chart review. RESULTS: Overall, 162 patients (115 inpatients and 47 outpatients) were included. The median age was 32 years (interquartile range [IQR], 24-42 years), and 59.3% were male. Six patients (3.7%) reported a history of DF. The median time from symptom onset to initial presentation was 3 days (IQR, 1-5 days), and 38 patients (23.5%) presented with warning signs (WS) at initial presentation. Among hospitalized patients, intravenous fluids were administered to 92.2%, with most receiving extracellular fluids. The median fluid volumes administered within 24 h, 72 h, and 7 days after diagnosis were 2569, 6769, and 10,011 mL, respectively, in severe disease; 1734, 5103, and 7855 mL in non-severe disease with WS; and 1500, 3650, and 5500 mL in non-severe disease without WS, respectively. These volumes were lower than those recommended by the World Health Organization and the Centers for Disease Control and Prevention. Nevertheless, no deaths or intensive care unit admissions occurred, and all inpatients were discharged without major sequelae. CONCLUSION: This study described the clinical management of DF in Japan. During hospitalization, effective fluid administration may be achievable with volumes lower than conventional recommendations. Further studies are warranted to determine optimal fluid administration strategies and volumes for adult patients with DF in high-resource, non-endemic settings, including Japan.