The clinical signs and symptoms of dengue are nonspecific as they mimic several other infectious diseases. The physician, therefore, must have a high index of suspicion for dengue and other medical conditions when these patients present. Naturally, rapid diagnosis and management will afford the best outcome for the patient.
The outcome may not be very good if the patient does not receive prompt medical therapy. However, aggressive treatment of dengue is usually successful, and death occurs in less than one percent of those cases.
Clinical Presentation
Clinical signs and symptoms of dengue include fever, severe headache, severe pain behind the eyes, joint pain, musculoskeletal discomfort, rash, and bleeding. There may be nosebleed, bleeding from the gums, or the patient can exhibit bruising of the skin. The presence of high fever and any two of the other signs and symptoms should lead the physician to strongly suspect that the patient has dengue infection (Centers for Disease Control, 2011).
Because of the severe musculoskeletal pain that occurs with this disease, physicians have in the past called it “break bone fever.”
The first occurrence of this medical condition tends to be less severe than subsequent bouts of it. With each episode of dengue, the patient is at risk for severe forms of the disease. Moreover, pediatric patients in the late childhood years and adults will, in general, experience more serious forms of dengue than will small children.
Circulatory Shock
Patients with dengue may progress to circulatory shock because there is an increase in the permeability of their capillaries. This leads to leakage of fluid into the peritoneum and pleural cavity. Hence, they require vigorous resuscitation with intravenous fluids in a hospital setting.
The blood loss in this condition, especially in dengue hemorrhagic fever, is the result of a decline in platelets. They may suffer from internal bleeding.
To treat the fever, antipyretic agents, such as acetaminophen, are beneficial in addition to intravenous fluids. However, the use of aspirin as an antipyretic agent is not the recommendation for these patients as it is a platelet inhibitor and may worsen the bleeding. Physicians also have the option to contact the Centers for Disease Control in the United States for further advice if they suspect that the patient has dengue.
Half of dengue cases will not show any obvious clinical signs or symptoms. There are, however, blood tests which will reveal the presence of antibodies to the virus and thus help to confirm the diagnosis.
Since dengue hemorrhagic fever or dengue shock syndrome are the most severe forms of the disease, physicians should also look for shortness of breath, pale, cold, or clammy skin, drowsiness or irritability, black or tarry stools, vomiting blood, abdominal pain, and red patches on the skin.
Most patients who receive adequate therapy will recover within a couple of weeks. Nevertheless, some adult patients will experience fatigue or psychological depression for several weeks or months.
Sources
- Centers for Disease Control. (2011). Dengue. Retrieved February 4, 2012.
- World Health Organization. (2012). Dengue and severe dengue. Retrieved February 4, 2012.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.
Michael Koger - Dr. Koger obtained his medical education at Meharry Medical College and specialized in Internal Medicine.
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