Dengue Symptoms According to W.H.O.

A person infected by the dengue virus develops severe flu-like symptoms. The disease, also
called 'break-bone' fever affects infants, children and adults alike and could be fatal. The clinical
features of dengue fever vary according to the age of the patient.
Individuals should suspect dengue when a high fever (40C/ 104F) is accompanied by two of
the following symptoms:

Severe headache
Pain behind the eyes
Nausea, Vomiting
Swollen glands
Muscle and joint pains
Rash

Symptoms usually last for 2-7 days, after an incubation period of 4-10 days after the bite from
an infected mosquito.
Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation,
respiratory distress, severe bleeding, or organ impairment. The warning signs to look out for
occur 3-7 days after the first symptoms in conjunction with a decrease in temperature (below
38C/ 100F) include:

Severe abdominal pain

Persistent vomiting
Rapid breathing
Bleeding gums
Blood in vomit
Fatigue, restlessness

The next 24-48 hours of the critical stage can be lethal; proper medical care is needed to avoid
complications and risk of death.

Complications and unusual manifestations

An increasing number of cases of DF or DHF-like disease have been associated with unusual
manifestations. These include such central nervous system phenomena as convulsion,
spasticity, changes in consciousness and transient paresis. A subtle form of seizure is
occasionally observed during the febrile phase in infants. This maybe only due to be normal in
such cases. Water intoxication resulting from the excessive administration of hypotonic solution
to treat Dengue High Fever or Dengue Shock Syndrome patients with hyponatremia may lead to
encephalopathy. Patients with encephalopathy as complication of disseminated intravascular
coagulation have also been reported.

Iatrogenic complications in the treatment of DHF/DSS may occur, such complications include
sepsis, pneumonia, wound infection and over-hydration. The use of contaminated intravenous
lines or fluids can result in gram-negative sepsis accompanied by fever, shock and severe
hemorrhage; pneumonia and other infections can cause fever and complicate convalescence.
Over-hydration can cause heart or respiratory failure, which may be mistaken for shock.
Other unusual reported manifestations include acute renal failure and hemolytic uremic
syndrome, sometimes with patients with G6PD deficiency and hemoglobinopathy. Simultaneous
infections, such as leptospirosis, viral hepatitis B, typhoid fever, chickenpox and melioidosis,
have been reported and could contribute to unusual manifestations of DHF/DSS.

Laboratory criteria for confirmation of dengue fever are;

Isolation of the dengue virus from serum or autopsy samples.

Demonstration of a fourfold or greater change in reciprocal IgG or IgM antibody titers to
one or more dengue virus antigens in paired serum samples.
Demonstration of dengue virus antigen in autopsy tissue, serum or cerebrospinal fluid
samples by immunochemistry, immunofluorescence or ELISA.
Detection of dengue virus genomic sequences in autopsy tissue serum or cerebrospinal
fluid by polymerase chain reaction (PCR).

Source: WHO Library Cataloguing-in-Publication Data. Dengue: guidelines for

diagnosis, treatment, prevention and control 9th edition.
Mortality Rate
With good medical management, mortality due to DHF can be less than 1%, but if left untreated
rate is as high as 50%