How to manage a patient with high fever, sore throat, and mild erythematous rash, with multiple mosquito bites, and stable vitals except for hyperthermia (fever of 39°C)?

Management Approach

This patient should be managed with hydration and supportive care (Option C), with antipyretics for fever control, while maintaining a high index of suspicion for mosquito-borne viral illness such as dengue fever. 1, 2

Initial Clinical Assessment

The presentation of high fever (39°C), sore throat, mild erythematous rash, and multiple mosquito bites with otherwise stable vitals suggests a mosquito-borne viral illness rather than bacterial infection requiring empiric antibiotics. 1, 2

Key Diagnostic Considerations

• Dengue fever is the most likely diagnosis given the constellation of fever, rash, and mosquito exposure, particularly if there is any travel history to endemic areas. 2
• The mild erythematous rash and sore throat are consistent with the febrile phase of dengue or other arboviral infections. 1
• Stable vitals (except fever) indicate the patient is not yet showing warning signs of severe disease such as hypotension or shock. 2

Immediate Management Strategy

Antipyretic Therapy

• Administer acetaminophen or ibuprofen for fever control to improve patient comfort and reduce fever-related symptoms. 1
• Avoid aspirin due to risk of hemorrhagic complications if this is dengue or another viral hemorrhagic fever. 1

Hydration and Supportive Care

• Oral or IV fluid resuscitation is the cornerstone of management for suspected arboviral illness, particularly dengue. 2
• Encourage oral fluids if the patient can tolerate them; if signs of dehydration develop, initiate IV isotonic crystalloids. 2
• Monitor for warning signs of plasma leakage including persistent tachycardia, rising hematocrit, or dropping platelet count. 2

Why NOT Empiric Antibiotics

• Empiric antibiotics are not indicated in this stable patient without signs of bacterial infection (no respiratory distress, no severe dehydration, no altered mental status, no signs of septicemia). 1
• The presentation is most consistent with viral illness, where antibiotics provide no benefit and may delay appropriate diagnosis. 1
• Antibiotics should be reserved for patients with high-risk features such as breathing difficulties, severe earache, vomiting >24 hours, drowsiness, or signs of bacterial superinfection. 1

Critical Monitoring Parameters

• Complete blood count with differential to assess for thrombocytopenia, leukopenia, and hemoconcentration (rising hematocrit indicates plasma leakage in dengue). 3, 2
• Serial vital signs every 4-6 hours to detect early signs of hemodynamic instability. 2
• Urine output monitoring as decreased output may indicate inadequate hydration or progression to severe disease. 2
• Watch for warning signs including abdominal pain, persistent vomiting, mucosal bleeding, lethargy, or hepatomegaly. 2

Common Pitfalls to Avoid

• Do not delay fluid resuscitation if warning signs develop—tachycardia with thrombocytopenia indicates early plasma leakage requiring immediate IV fluids. 2
• Do not give prophylactic platelet transfusions even if thrombocytopenia develops; they are only indicated for severe bleeding or platelets <20,000/mm³ before invasive procedures. 2
• Protect the patient from further mosquito exposure during the first few days of illness to prevent transmission if this is dengue or another arboviral infection. 1

When to Escalate Care

• Admit to hospital if the patient develops signs of severe dehydration, altered mental status, severe bleeding, hypotension, or respiratory distress. 1, 2
• Consider ICU admission if severe criteria develop including parasitemia >5% (if malaria), severe anemia, renal impairment, or metabolic acidosis. 3