Dengue is a rapidly spreading mosquito-borne viral infection endemic to parts of Africa, Asia, and Central and South America. The illness includes an incubation period of 4 to 10 days, an acute febrile phase lasting 2 to 7 days, a critical phase beginning around the time of defervescence and lasting 1 to 2 days, and a recovery phase lasting 2 to 3 days.
Recommend mosquito avoidance to prevent dengue, including covering skin, the use of screens, and applying mosquito repellants containing DEET.
Ask patients with suspected dengue about typical symptoms including fever, headache, myalgias, rash, and GI symptoms.
Look for physical exam findings that suggest a diagnosis of dengue, including rash, abdominal tenderness, signs of hemorrhagic manifestations, and signs of circulatory compromise.
Obtain a CBC in patients with suspected dengue.
Use PCR, serology, or viral culture to confirm the diagnosis. Note that cell culture and PCR are useful early in the illness during the acute febrile phase.
Grade the severity of dengue to offer optimal management; look for warning signs and criteria for severe dengue and hospitalize patients with warning signs or severe disease.
Provide fluid replacement for all patients with dengue and monitor them closely.
Use blood transfusions in patients with significant hemorrhagic manifestations.
Use appropriate drugs to provide supportive care to patients with dengue. Consider treatment with acetaminophen, diazepam for seizures, and PPIs or H2-blockers for patients with gastrointestinal bleeding.