What are the danger signs of dengue?

Danger Signs of Dengue

The danger signs of dengue that require immediate medical attention include persistent vomiting, abdominal pain/tenderness, clinical fluid accumulation, mucosal bleeding, lethargy/restlessness, hepatomegaly, and hematocrit rise with concurrent thrombocytopenia. 1

Warning Signs According to WHO Classification

• Persistent vomiting (inability to keep down oral fluids) 1, 2
• Abdominal pain or tenderness, which may indicate developing complications 1, 3
• Clinical fluid accumulation (pleural effusion, ascites) 1, 3
• Mucosal bleeding (gums, nose, gastrointestinal tract) 1, 3
• Lethargy or restlessness, which may indicate neurological involvement 1, 3
• Hepatomegaly (>2 cm), indicating liver involvement 1, 3
• Laboratory evidence: Hematocrit rise with concurrent rapid drop in platelet count 1, 2

Timing and Significance

• Warning signs typically appear around days 3-7 of illness, coinciding with defervescence (when fever begins to subside) 1, 4
• These signs often precede the development of severe dengue by approximately two days 5
• The presence of any warning sign warrants close monitoring and consideration for hospitalization 1, 4

Clinical Implications

• Early recognition of warning signs can reduce case-fatality rate to less than 0.5% 1
• Patients exhibiting warning signs should be monitored daily with complete blood counts to track platelet counts and hematocrit levels 2
• Persistent vomiting, hepatomegaly, hematocrit rise with rapid platelet drop, and clinical fluid accumulation are highly specific (>90%) for progression to severe dengue 5

Additional Concerning Signs

• Gastrointestinal bleeding is a serious complication that occurs in approximately 0.3% of dengue cases 6
• Acute pancreatitis, though rare, can present as a complication of dengue hemorrhagic fever 7
• Comorbidities significantly increase the risk of developing severe dengue 3
• Impaired consciousness and dyspnea are associated with higher risk of severe disease 3

Severe Dengue Manifestations

• Severe plasma leakage leading to shock or fluid accumulation with respiratory distress 2, 4
• Severe bleeding as evaluated by clinician 2, 4
• Severe organ involvement (liver, central nervous system, heart, or other organs) 2, 4

Diagnostic Considerations

• Daily monitoring of complete blood count is essential to track platelet counts and hematocrit levels in patients with warning signs 2
• Liver function tests should be considered as approximately 70% of hospitalized dengue patients show alterations 6
• Patients with abdominal and gastrointestinal symptoms are significantly more likely to require hospitalization (74% vs. 26%, p=0.0001) 6

Common Pitfalls to Avoid

• Failing to recognize warning signs early, particularly during the critical phase when fever subsides 1, 4
• No single warning sign has sensitivity >64% for predicting severe disease, so multiple signs should be considered together 5
• Administering NSAIDs or aspirin, which can increase bleeding risk in dengue patients 2
• Delaying fluid resuscitation in patients showing signs of shock 2