Acute febrile illness due to dengue virus (DENV 1–4) transmitted by Aedes mosquito; spectrum from undifferentiated fever to severe dengue.
History taking
- • Sudden high fever (3–7 d), retro-orbital pain, myalgia, arthralgia, headache
- • Rash on day 3–5, nausea, vomiting
- • Warning signs: severe abdominal pain, persistent vomiting, mucosal bleed, lethargy, restlessness
Examination
- • Flushed face, tourniquet test, petechiae
- • Volume status — capillary refill, postural BP, pulse pressure
- • Hepatomegaly, free fluid (ascites, pleural effusion)
Red flags
- • Warning signs (above)
- • Severe plasma leakage (shock, respiratory distress)
- • Severe bleeding, organ involvement (AST/ALT >1000, encephalopathy)
Differential diagnosis
- • Chikungunya, malaria, leptospirosis, scrub typhus, viral fever, COVID-19
Recommended investigations
- • CBC daily — falling platelets, rising haematocrit
- • NS1 antigen (day 1–5), IgM/IgG (after day 5)
- • LFT, RFT, electrolytes, coagulation, ABG if severe
- • USG abdomen / chest for plasma leakage
Diagnosis
- • WHO 2009: dengue without warning signs / with warning signs / severe dengue
Initial treatment / management
- • Group A (no warning): oral fluids 2.5–3 L/d, paracetamol, daily CBC
- • Group B (warning signs): IV crystalloid (RL) 5–7 mL/kg/h, titrate by HCT and urine output
- • Group C (severe): aggressive resuscitation per WHO algorithm; ICU
- • Avoid NSAIDs, aspirin, IM injections
Prescription examples
- • Tab Paracetamol 500–1000 mg PO 6 hourly (max 4 g/d)
- • Oral fluid (ORS, soups, fresh juice) — 2.5 L/day
- • Strictly avoid Aspirin, Ibuprofen, Diclofenac
Follow-up advice
- • Daily CBC during febrile phase; admit if warning signs or platelets <50k
- • Critical phase day 4–6 — monitor closely for plasma leak
Patient counselling
- • Mosquito source reduction, repellents, full-sleeve clothing
- • Recognise warning signs and seek care immediately
Referral criteria
- • Warning signs, severe dengue, pregnancy, infants
- • Co-morbid (CKD, IHD), elderly, immunocompromised
Clinical pearls
- • Defervescence (day 3–6) heralds the critical phase — vigilance for shock
- • Platelet transfusion only if active bleed or count <10k
- • Fluid overload is the leading iatrogenic cause of death in severe dengue
References
- • WHO Dengue Guidelines for Diagnosis, Treatment, Prevention 2009 / 2023 addendum
- • National Guidelines for Clinical Management of Dengue NVBDCP 2014
Educational outpatient guide — verify against local guidelines before clinical use.
