What are the warning signs of dengue fever?

Dengue Classification

Presently, the healthcare community has to deal with the endemic of dengue, on top of COVID-19. Both these diseases are viral in origin, and present with high grade fever and fatigue. Therefore, medical specialists like Best Internal Medicine specialist in Lahore rely on lab investigations and clinical presentations to confirm the diagnosis of dengue.

In mild disease, the symptoms of dengue are similar to flu or a generic viral infection. However, patient can take a sudden turn for the worse, with need for immediate intervention. Read on to know more about the warning signs of dengue and how to recognize them:

Symptoms of dengue

Dengue fever becomes symptomatic about four to six days after the virus enters the body. It lasts for up to ten days and during this time, the patient experiences:

Fever: dengue involves high fever (more than 102 F). The term used for dengue fever is ‘bone-breaking fever’ due to the accompanying pain it causes.

Muscle pain: is quite common in dengue. The pain is severe enough to feel as if the bones are breaking.

Pain behind the eyes: retroocular pain is characteristic of dengue.

Nausea and vomiting: the patient feels malaise and refuses to eat much due to the concurring nausea and vomiting.

Swollen glands: salivary glands in the mouth are often swollen in dengue fever.

Rash: a rash may or may not occur in dengue. However, in a suspected patient it is a strong indicator of dengue. It may occur two to five days after the onset of fever.

Liver enlargement: involvement of liver may occur in the later phases of the disease and denotes more serious illness.


Phases of disease

Phase I: fever
The first phase dengue is predominantly fever with pain and body aches. This phase lasts from between three to five days.

Phase II: critical period
The second phase—lasting for two days—needs the most careful management of the patient, with a lookout for the warning symptoms. During this phase the body temperature comes down and patient looks clinically better. However, during this phase, the fluid may shift from the intravascular compartment to the extravascular compartment, leading to severe dehydration, fall in blood pressure and ultimately circulatory collapse. The fluid may accumulate in the abdominal space or lungs—the latter leading to difficulty in breathing.

If prompt medical help is not provided in this phase, the patient can go into organ failure with irreversible damage. Fluid management given later on, is not enough to reverse the damage, which is why prompt diagnosis of the critical phase by the healthcare provider is needed.

Phase III: recovery
The fluid that has leaked from the intravascular compartment now shifts back. At this phase, the patient is on the road to recovery and may urinate more.

Warning signs

The warning symptoms and signs are related to the critical phase of the disease. As mentioned before, there is fluid shift during phase II that can dehydrate the patient. Consequently, without fluid replacement, there is circulatory failure.

Additionally, the platelets or the blood cells needed for clotting are falling in the course of disease. If their number drops dangerously, there may be spontaneous bleeding, with blood in the gums, like petechiae on the skin, blood in the stool or urine, bleeding from nose or in the joints. These warning signs should prompt the healthcare provider to admit and monitor the patient.

Once the patient is admitted, the healthcare provider monitors the vital signs, including the pulse and blood pressure to check for signs of shock.

Dengue needs proper management and evaluation. Virtual or in-office appointment can be booked through oladoc.com.

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By Nimra Zubair

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