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Diagnosis n treatment of Dengue fever

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Diagnosis of dengue fever

Dengue is suspected in a person from, or recently travelling to, an area with dengue transmission who develops acute fever, usually with:
  • Severe headache or pain behind the eyes
  • Muscle and joint aches ("break-bone" pain)
  • Nausea, vomiting, rash, or marked fatigue
  • Low white-cell count and/or low platelet count
  • Mild bleeding such as gum bleeding, nosebleeds, easy bruising, or tiny red skin spots

Tests

  • Days 0-5 of illness: dengue NS1 antigen or RT-PCR is most useful.
  • From about day 5 onward: dengue IgM antibody testing becomes more useful.
  • Monitoring tests: complete blood count and hematocrit, repeated if clinically indicated. A falling platelet count with a rising hematocrit can indicate plasma leakage and worsening disease.
A clinician must also exclude malaria, chikungunya, typhoid, COVID-19, bacterial sepsis, and other causes of fever depending on setting.

Treatment

There is no routine antiviral drug that cures dengue. Treatment is supportive and careful monitoring is the mainstay.

Uncomplicated dengue, managed at home only if medically appropriate

  • Fluids: Drink frequent oral fluids, oral rehydration solution, soups, and water. Monitor urine output.
  • Fever/pain: Use paracetamol (acetaminophen) only, following the label or clinician's advice.
  • Rest and avoid strenuous activity.
  • Attend scheduled follow-up and repeat blood counts if advised, especially around days 3-7.

Avoid

  • Aspirin
  • Ibuprofen, naproxen, diclofenac, and other NSAIDs
  • Intramuscular injections when avoidable
  • Alcohol and dehydration
These can increase bleeding risk or worsen kidney/liver problems.

Hospital treatment

Admission and close monitoring are needed for severe dengue, inability to drink, dehydration, high-risk patients, significant bleeding, shock, organ dysfunction, pregnancy, infancy, older age, or important chronic illness.
In hospital, management may include:
  • Frequent assessment of pulse, blood pressure, hematocrit, platelets, urine output, and signs of fluid leakage
  • Carefully calculated IV isotonic fluids if oral intake is inadequate or there is shock/plasma leakage
  • Treatment of bleeding, shock, or organ complications in a higher-level care unit when required
Platelet transfusion is not given just because the platelet count is low. It is generally considered for significant active bleeding or specific clinical circumstances, not as routine prevention.

Danger signs: seek urgent emergency care

Dengue can worsen as the fever starts settling, commonly around days 3-7. Go to urgent care immediately for:
  • Severe or persistent abdominal pain
  • Repeated vomiting
  • Bleeding from gums/nose, vomiting blood, black stools, heavy menstrual bleeding, or new extensive bruising
  • Extreme weakness, restlessness, confusion, fainting, cold clammy hands/feet
  • Trouble breathing
  • Very little urine or inability to keep fluids down
  • Rapid worsening after fever decreases
If this is about a current illness, prompt in-person medical assessment and appropriate dengue testing are advisable, particularly if you are in a dengue-endemic area or have any warning signs.
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