A Proposal of Early Diagnosis and Early Management in Dengue Infection and Possible COVID-19

Dengue infection may lead to various sequels, such as undifferentiated fever (UF), dengue fever (DF), or dengue hemorrhagic fever (DHF), progressive illness, and death. It also causes significant economic burdens that are associated with health-care costs and loss of labor. Usually, the treatment of dengue infection is supportive therapy and not the specific treatment for it, while it is often clinically difficult to predict whether dengue-infected patients will progress to severe diseases or not. We here propose integrated management strategies for early dengue virus (DENV) infection based on our 5-year experience in early management of dengue infection, literature reviews, and research studies over the last 10 years. This proposal consists of 4 aspects: (1) rehydration with oral rehydration therapy, (2) reduction of the pro-inflammatory cytokines, including TNF-α and IL-6 with oral cytokine inhibitors i.e., pentoxifylline and doxycycline, (3) inhibition of DENV replication, viral load reduction, nonstructural protein 1 antigen (NS1Ag) clearance with doxycycline and ivermectin, (4) restoration of the immune function with vitamin D and zinc supplementation. The major benefit of these drugs and supplements is that they are already approved by regulatory bodies, affordable, and clinically safe. They result in better clinical and laboratory outcomes, including in a reduction in hospitalization and cost of treatment. Another benefit is that it may use this strategy for other virus-induced hypercytokinemia such as coronavirus disease (COVID-19) and Ebola.