assessment of possible dengue fever

Last reviewed 01/2018

assessment of suspected dengue fever

A patient presenting with a history of foreign travel, fever, generalised skin flushing, leucopenia, and thrombocytopenia should alert clinician about dengue fever.
Obtain a thorough history.

  • important histories include:
    • date of onset of fever/illness
    • symptoms and severity
    • 3 golden questions
      • oral fluid intake – quantity and quality
      • urine output - frequency, volume and time of last voiding
      • activities patients can carry out during febrile illness
    • other fluid losses – diarrhoea, vomiting
    • presence of warning signs
  • other relevant histories include:
    • family or neighbourhood dengue, travel to dengue endemic areas
    • medications (including non prescription and traditional medicine)
    • risk factors - infancy, pregnancy, obesity, diabetes mellitus, hypertension)
    • jungle trekking and swimming in waterfall - consider leptospirosis, typhus, malaria
    • recent unprotected sex or drug abuse - consider acute HIV seroconversion illness

Physical examination should include:

  • general assessment
    • mental state
    • hydration status
    • haemodynamic status
  • clinical evidence of warning signs
    • bleeding manifestations : mucosal bleeding
    • abdominal tenderness
    • liver enlargement
    • fluid accumulation – plural effusion, ascites
  • other important signs
    • tachypnoea/acidotic breathing – indicates shock
    • rash
    • tourniquet test - repeat if previously negative or if there is no bleeding manifestation

A full blood count should be carried out in all patients with symptoms.

Based on the history, physical examination and/or full blood count and haematocrit, clinicians should determine:

  • whether the disease is dengue
  • if dengue, the phase of the infection – febrile, critical, recovery
  • presence of warning signs
  • hydration and hemodynamic status of the patient
  • admission to a hospital is necessary or not (1,2)

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