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Dengue in detail

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Dengue is an acute mosquito-borne viral illness, ranging from a self-limited fever to severe dengue with shock, bleeding, and organ involvement.

Topic map

  1. Cause and transmission - dengue virus serotypes, Aedes mosquitoes, epidemiology
  2. Pathogenesis - viraemia, immune response, capillary leak, secondary infection
  3. Clinical features - febrile, critical, and recovery phases; warning signs
  4. Classification - dengue without warning signs, with warning signs, severe dengue
  5. Diagnosis - CBC trends, NS1 antigen, PCR, IgM/IgG, differential diagnosis
  6. Management - outpatient care, fluid therapy, monitoring, admission and referral criteria
  7. Severe dengue - shock, haemorrhage, plasma leakage, organ impairment
  8. Special situations - children, pregnancy, older adults, comorbid illness
  9. Prevention - mosquito control, personal protection, vaccines
  10. Complications and prognosis - recovery, follow-up, danger signs requiring urgent care
High-level overview: Dengue is transmitted mainly by day-biting Aedes aegypti mosquitoes. After an incubation period typically around 4-10 days, patients often develop abrupt fever, severe headache, retro-orbital pain, myalgia, arthralgia, nausea, and rash. A fall in platelet count may occur, but the key indicator of dangerous plasma leakage is a rising haematocrit together with clinical deterioration.
The period around defervescence, often days 3-7 of illness, can be hazardous. Warning signs include abdominal pain or tenderness, persistent vomiting, mucosal bleeding, lethargy or restlessness, fluid accumulation, liver enlargement, and rising haematocrit with rapidly falling platelets. Severe dengue is defined by severe plasma leakage causing shock or respiratory distress, severe bleeding, or severe organ involvement. Treatment is supportive, especially carefully titrated isotonic fluids and close monitoring. Avoid aspirin and NSAIDs because of bleeding risk.
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