What are the most important things to report to the infectious disease attending when admitting a dengue patient?

Critical Information to Report When Admitting a Dengue Patient

When admitting a dengue patient to the infectious disease attending, immediately report the presence and number of warning signs, current platelet count and hematocrit trends, hemodynamic status, and day of illness to guide risk stratification and management decisions.

Essential Clinical Information

Day of Illness and Disease Phase

• Report the exact day of fever onset (incubation period 4-8 days), as dengue characteristically follows a triphasic course: febrile phase, critical phase (typically days 3-7), and recovery phase 1, 2
• The critical phase is when plasma leakage and shock typically occur, making timing crucial for management decisions 3

Warning Signs Assessment

• Enumerate the specific warning signs present, as the presence of 5 or more warning signs significantly predicts severe dengue (odds ratio 5.14) 4
• Key warning signs include: persistent vomiting, severe abdominal pain, clinical fluid accumulation, lethargy/restlessness, mucosal bleeding, liver enlargement >2 cm, and rising hematocrit with rapidly falling platelet count 1, 3
• Persistent vomiting is particularly critical as it prevents adequate oral hydration and mandates hospitalization 1, 3

Laboratory Trends (Not Just Absolute Values)

• Report platelet count trajectory, not just the current value—rapidly decreasing platelets are a warning sign even if not yet critically low 1, 5
• Platelet counts <20,000 cells/mm³ are significantly associated with severe disease (odds ratio 3.089 to 14.71) 4
• Report hematocrit trends: a >20% increase from baseline indicates plasma leakage and impending shock 1, 3
• Lymphocyte counts <1,500 cells/mm³ are significantly associated with severe dengue (odds ratio 3.367) 4
• AST levels are important—elevated AST is significantly associated with severe disease (odds ratio 27.26), particularly in patients with abdominal pain 4

Hemodynamic Status

Vital Signs and Perfusion

• Report blood pressure, pulse pressure, heart rate, and capillary refill time to assess for early shock 3
• Narrow pulse pressure (<20 mmHg) or hypotension indicates dengue shock syndrome 3
• Cold, clammy extremities are early signs of shock requiring immediate fluid resuscitation 1

Fluid Balance

• Report oral intake adequacy and urine output (normal is >0.5 mL/kg/hour in adults) 3
• Document whether the patient can maintain oral hydration or requires IV fluids 1

Bleeding Manifestations

• Report any bleeding, including mucosal bleeding, petechiae, or significant hemorrhage, as this may require blood product transfusion 1, 3
• Bleeding combined with thrombocytopenia and plasma leakage defines dengue hemorrhagic fever 3

Diagnostic Confirmation Status

• Report whether dengue is confirmed or suspected and by what method (PCR positive if <5-7 days of symptoms, or IgM capture ELISA if >5-7 days) 6, 3
• Note any cross-reactivity concerns with other flavivirus vaccinations (yellow fever, Japanese encephalitis, tick-borne encephalitis) 6

Current Management and Response

• Report what has been given: acetaminophen/paracetamol is appropriate for fever and pain; confirm no NSAIDs or aspirin have been administered due to bleeding risk 1, 3
• Document fluid resuscitation already provided and the patient's response 3

Common Pitfalls to Avoid When Presenting

• Do not report only a single platelet count—the trend is more important than the absolute value for risk stratification 1, 5
• Do not delay reporting signs of shock while waiting for complete laboratory results—clinical signs of poor perfusion require immediate action 1
• Do not focus solely on fever—persistent fever alone without other warning signs or clinical deterioration does not necessarily indicate severe disease or secondary infection 3
• Do not report "stable" without quantifying—specify actual vital signs, urine output, and mental status rather than subjective assessments 3

Risk Stratification Context

• Patients are classified into risk groups based on findings and comorbidities to determine outpatient versus inpatient management 2
• Severe dengue (shock, severe bleeding, organ impairment) carries 1-5% mortality but is rare, occurring in <10% of cases 2
• Most dengue infections are mild and self-limiting, but early recognition of warning signs prevents progression to severe disease 1, 2