Timing of Plasma Leakage in Dengue with Mild Ascites
Plasma leakage in dengue typically begins 2 days before defervescence (fever resolution) and can be detected as early as 3 days after fever onset, lasting approximately 48 hours before spontaneous resolution. 1
Timeline of Plasma Leakage Detection
Early Detection Window
- Ultrasonographic evidence of plasma leakage starts appearing 2 days before the fever breaks, which is the most critical period to monitor 1
- In some cases, plasma leakage can be detected within 3 days after fever onset, making early ultrasound surveillance valuable 1
- The leakage phase lasts only 48 hours and resolves spontaneously if properly managed 2
Critical Phase Timing
- The critical phase of dengue typically occurs on days 3-7 of illness, when plasma leakage can rapidly progress to shock 3
- This corresponds to the defervescence period when patients transition from the febrile to the critical phase 1
Ultrasonographic Findings and Their Timeline
Sequence of Appearance
- Pleural effusion is the earliest and most common sign (detected in 62% of DHF cases one day after defervescence) 1
- Gallbladder wall thickening appears in 43% of cases and shows a characteristic reticular pattern in 87.9% of severe dengue cases 4, 1
- Ascites is detected in 52% of DHF cases, appearing slightly later than pleural effusion 1
Resolution Pattern
- Gallbladder wall thickening and ascites resolve more rapidly than pleural effusions 1
- All ultrasonographic findings are transient and completely resolve by 7 days or at discharge 4
Clinical Implications
Monitoring Strategy
- Daily ultrasound examinations during the critical phase (days 3-7) can detect plasma leakage before hematocrit changes become apparent 1
- Ultrasound detected plasma leakage in 12 of 17 DHF cases who did not meet criteria for significant hemoconcentration, making it more sensitive than hematocrit monitoring alone 1
Warning Signs During Leakage Phase
- Monitor for high hematocrit with rapidly falling platelet count, severe abdominal pain, persistent vomiting, lethargy or restlessness, and mucosal bleeding 3
- Rising hematocrit indicates ongoing plasma leakage and need for continued resuscitation 3
Common Pitfall to Avoid
- Failing to recognize the critical phase (days 3-7) when plasma leakage can rapidly progress to shock is a major cause of mortality 3
- The 48-hour window of plasma leakage requires intensive monitoring, as unanticipated severity of leakage due to failure to recognize and treat is directly related to mortality 2