Dengue Disease Summary

Overview

Dengue has been endemic in Southeast Asia in the past years. The Introduction section tells the course of the disease, while details on the incidence and mortality rates in Asia are in the Epidemiology section. 

Transmission of dengue through the bite of the Aedes mosquito, the incubation period and the different serotypes have been discussed in the Pathophysiology section. 

Dengue_Disease SummaryDengue_Disease Summary


Conditions that increase the likelihood of developing severe dengue are enumerated in the Risk Factors section.  The World Health Organization (WHO) 2009 classification of Dengue as well as the old classification has been discussed in the Classification section. 

History and Physical Examination

There are three phases of dengue infection and in the Clinical Presentation section, the signs and symptoms of these phases are discussed.

Diagnosis

Several tests that can be done to diagnose dengue are enumerated and discussed in the Laboratory Tests and Ancillaries section.

Other conditions which present with a syndrome similar to dengue have to be ruled out and these are listed in the Differential Diagnosis section.

Management

The criteria for home management, hospitalization and emergency treatment of patients infected with the dengue virus are in the Evaluation section, while symptomatic and supportive therapies, including fluid replacement therapy and blood transfusion, are discussed in the Pharmacological Therapy and Nonpharmacological sections.

Dengue infection can be prevented through different methods of vector control and by vaccination that are in detailed in the Prevention section.

Continuous tracking of patient’s status, particularly those with shock, and the effectiveness of treatment are discussed in the Monitoring section.

Hemorrhagic complications, fluid overload and other complications of dengue infection are presented in the Complications section.

Frequently Asked Questions

What warning signs suggest severe dengue risk?
Warning signs include abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy or restlessness, liver enlargement, and a rising hematocrit with rapid platelet decline. These features often appear around defervescence and indicate increased capillary leakage or bleeding risk. Patients with warning signs require close monitoring and often hospital assessment. Clarification: defervescence is the period when fever settles and severe manifestations may emerge. Read more: https://www.mims.com/singapore/disease/dengue/initial-assessment?subsection=warning-signs
Which tests confirm dengue in early illness?
In early illness, virologic tests are most useful, particularly NS1 antigen detection and nucleic acid amplification tests. These are generally more informative during the first few days of fever, before antibody responses become prominent. Serology becomes more useful later in the course. Full blood count also supports assessment by showing leukopenia, thrombocytopenia, and hemoconcentration. Clarification: test selection should be guided by day of illness and local laboratory availability. Read more: https://www.mims.com/singapore/disease/dengue/diagnostics?subsection=laboratory-tests-ancillaries
How should fluids be managed in dengue?
Fluid therapy should be individualized according to hemodynamic status, oral intake, urine output, hematocrit trend, and evidence of plasma leakage. Patients without shock may be managed with oral fluids or carefully titrated intravenous crystalloids if needed. Those with shock need prompt isotonic crystalloid resuscitation and frequent reassessment to avoid both under-resuscitation and fluid overload. Clarification: the critical phase is dynamic, so fluid rates should be adjusted repeatedly rather than prescribed once. Read more: https://www.mims.com/singapore/disease/dengue/management?subsection=nonpharmacological
Which medicines should be avoided in dengue?
Avoid aspirin, nonsteroidal anti-inflammatory drugs, and other agents that can increase bleeding risk or worsen gastritis. Intramuscular injections are also best avoided because they may provoke hematoma formation in thrombocytopenic patients. Paracetamol is generally preferred for fever and pain, within recommended dosing limits. Clarification: medication review should include prescribed, over-the-counter, and traditional products because antiplatelet and anticoagulant effects may be overlooked. Read more: https://www.mims.com/singapore/disease/dengue/management?subsection=pharmacological-therapy
What follow-up monitoring is needed after diagnosis?
Follow-up should focus on daily clinical review during the febrile and early critical phases, with attention to warning signs, hydration, urine output, bleeding, hematocrit, and platelet count where indicated. Patients and caregivers should receive clear return precautions, especially around defervescence. Monitoring continues until recovery is evident and there is no ongoing plasma leakage or hemodynamic instability. Clarification: falling platelets alone do not define severity; the overall clinical trend is more important. Read more: https://www.mims.com/singapore/disease/dengue/follow-up?subsection=monitoring