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

Management of Suspected Arboviral Illness

The most appropriate management for this patient is hydration and supportive care (Option C), as the clinical presentation of high fever, sore throat, mild erythematous rash, and multiple mosquito bites with otherwise stable vitals strongly suggests a mosquito-borne viral illness such as dengue fever, which does not require empiric antibiotics and is managed primarily with fluid resuscitation and symptomatic treatment. 1

Initial Clinical Assessment

The constellation of findings points toward arboviral illness rather than bacterial infection:

• High fever with mosquito exposure is the hallmark of dengue and other arboviral infections, particularly when accompanied by a mild erythematous rash 1
• Stable vital signs (except fever) argue against severe bacterial sepsis requiring immediate empiric antibiotics 1
• Sore throat and rash are consistent with the febrile phase of dengue or other arboviral infections 1

The CDC emphasizes maintaining a high index of suspicion for mosquito-borne viral illness in patients presenting with this clinical picture 1

Why Supportive Care is the Correct Answer

Hydration as Cornerstone of Management

• Oral or IV fluid resuscitation is the cornerstone of management for suspected arboviral illness, particularly dengue 1
• Patients should increase fluid intake as febrile illness is accompanied by mild dehydration 2
• Patients with signs of moderate dehydration should be given oral rehydration solution 2

Antipyretic Therapy

• Acetaminophen (paracetamol) is preferred for fever control to improve patient comfort 2, 1
• Ibuprofen can be used for fever control according to the American Academy of Pediatrics 1
• Avoid aspirin due to risk of hemorrhagic complications if this is dengue or another viral hemorrhagic fever 1

Why Empiric Antibiotics are NOT Indicated

The clinical presentation does not support bacterial infection requiring empiric antibiotics:

• No evidence of bacterial sepsis: Vitals are stable except for fever, with no hypotension, tachycardia, or signs of shock 2
• Mosquito-borne viral illness is more likely given the exposure history and clinical features 1
• Antibiotics should be reserved for patients with evidence of organ dysfunction, severe thrombocytopenia, mental status changes, or when bacterial infection cannot be excluded 2

Critical Monitoring Parameters

Close monitoring is essential to detect early deterioration:

• Complete blood count with differential to assess for thrombocytopenia, leukopenia, and hemoconcentration 1
• Serial vital signs every 4-6 hours to detect early signs of hemodynamic instability 1
• Assess for warning signs: severe abdominal pain, persistent vomiting, bleeding, altered mental status, or respiratory distress 1

When to Escalate Care

Hospitalization is indicated if the patient develops:

• Signs of severe dehydration, altered mental status, severe bleeding, or hypotension 1
• Evidence of organ dysfunction or severe thrombocytopenia 2
• Respiratory distress or hypoxia (oxygen saturations <95%) 2
• Metabolic acidosis (base deficit >8 mmol/L) 2

Diagnostic Considerations

While supportive care should be initiated immediately, consider:

• Dengue PCR on acute blood sample if available 3
• Malaria testing if there is travel history to endemic areas within the past year 4
• Blood cultures only if bacterial sepsis cannot be excluded or if fever pattern changes 3

Common Pitfalls to Avoid

• Do not delay supportive care while awaiting laboratory confirmation 2
• Do not use aspirin for fever control in suspected arboviral illness 1
• Do not prescribe empiric antibiotics without clear evidence of bacterial infection, as this contributes to antimicrobial resistance 1
• Ensure close follow-up if managing as outpatient, as patients can deteriorate rapidly 2