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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