Dengue fever is a viral infection, transmitted to humans through the bite of infected female mosquitoes. The virus responsible for causing Dengue is called dengue virus (DENV), and it has four serotypes. The primary vector that transmit the disease are Aedes aegypti mosquitoes and, to a lesser extent, Aedes albopictus.

Although Dengue fever is considered a year-round and nationwide risk in India, but the highest risk is typically in June - September.

Dengue fever usually presents as one of the following:

  • Dengue without warning signs
  • Dengue with warning signs
  • Severe dengue (Dengue hemorrhagic fever)

Most cases fall in the category of dengue without warning signs, and are treated on an outpatient basis. Such patients and caregivers should be aware of the home care methods and warning signs, and when to visit the nearest hospital. 

Dengue without warning signs

Symptoms are :

  • High grade fever+ 2 of the following:
  • Severe headache 
  • Retro orbital pain
  • Myalgia/ arthralgia ( Break bone fever)
  • Maculopapular exanthem
  • Generalised lymphadenopathy

Treatment given : 

  • Bed rest
  • Fever control with Paracetamol and tepid sponging
  • DO NOT GIVE ASPIRIN OR IBUPROFEN
  • Prevent dehydration with oral fluids and ORS
  • Watch out for signs of dehydration 
  • Use of bed nets and mosquito repellant 

These patients do not need hospitalization, but one should look out for warning signs.

Dengue with warning signs 

Critical period:Occurs 3-4 days after symptom onset.

Warning signs appear after fever subsides, and are:

  • Abdominal pain
  • Persistent vomiting
  • Hepatomegaly ( enlarged liver)
  • Fluid leak in 3rd spaces i.e. pleural effusion, ascites
  • Raised hematocrit levels 
  • Gingival bleed, petechiae, epistaxis

These patients should be admitted to hospital for:

Monitoring of hematocrit, fluid intake and output, vitals, platelets. 

Individualised management

Severe dengue ( Dengue hemorrhagic fever)

These patients may present with:

  • Severe hemorrhagic manifestations like petechiae, echymoses, purpura
  • Thrombocytopenia ( platelets<10,000/ cumm)
  • Hypothermia to second fever spike
  • Hepatomegaly, liver failure
  • Changes in mental status, confusion
  • Plasma leak i.e. ascites, respiratory distress 
  • Decreased hematocrit 

These patients should be admitted to the hospital for emergency treatment, where they are monitored and managed on  individualized basis according to their needs and response to treatment.