Dengue Initial Assessment

Clinical Presentation

Phases of Dengue Infection

Febrile Phase  

During the febrile phase, the patient suddenly develops a high-grade fever that commonly lasts for 2-7 days and is associated with facial flushing, skin redness, generalized arthralgia, myalgia, headache, anorexia, nausea, and vomiting. It may also be accompanied by sore throat, injected pharynx, conjunctival injection, and mucosal or gastrointestinal bleeding.  

The likelihood of dengue infection is increased by a positive tourniquet test and a progressive decrease in total WBC count. The progression to the critical phase should be recognized promptly by monitoring for warning signs and other clinical parameters.  

Critical Phase  

The critical phase occurs on days 3-7 of illness and usually lasts for 1-2 days. The patient’s temperature lowers to ≤37.5-38°C and may have an increase in capillary permeability concurrent with an increase in hematocrit level. The patient may develop pleural effusion, ascites, shock, organ impairment, metabolic acidosis, or disseminated intravascular coagulation which may lead to severe hemorrhage depending on the degree of plasma leakage and the volume of fluid therapy.            

Other patients may proceed with this phase even without defervescence. The changes in the full blood count may be the only guide to determining the onset of plasma leakage.  

Recovery Phase  

The recovery phase is 2-3 days after the critical phase has been successfully surpassed. Patients may present with respiratory distress due to massive pleural effusion and ascites if excessive intravenous fluids were given.