What is the fever pattern in Dengue (Dengue Virus) fever?

From the Guidelines

Dengue fever is characterized by a biphasic fever pattern, with an initial high-grade fever lasting 3-7 days, followed by a brief period of defervescence, and then a second fever spike coinciding with the critical phase of the illness. This pattern is crucial for clinical recognition, as the period between fever spikes can falsely suggest improvement while actually preceding the potentially dangerous critical phase. The initial fever corresponds to viremia, and the second spike relates to immunological responses and potential complications such as plasma leakage, hemorrhage, and shock 1. Key features of the fever pattern in dengue fever include:

• High-grade fever (often 104-105°F or 40-40.5°C) during the acute febrile phase
• Brief period of defervescence lasting 1-2 days
• Second fever spike creating the characteristic "saddleback" or biphasic fever pattern
• Second febrile phase usually lasting 1-2 days and coinciding with the critical phase of the illness It is essential to monitor patients with suspected dengue fever closely, as the biphasic fever pattern can be indicative of the disease's progression and potential complications, and appropriate management should be provided to monitor and treat shock and hemorrhage 1.

From the Research

Fever Pattern in Dengue Fever

• The common presentation of dengue fever is fever, observed in 100% of the patients 2.
• The mean duration of fever in patients with dengue is 5.1 days (95% CI: 4.7-5.5) days 3.
• Longer duration of fever is seen in those with a higher grade of fever, those with higher disease severity, and those with concurrent bacterial infections 3.
• In the absence of risk factors for concurrent bacteremia, antimicrobials may be unnecessary in those with dengue fever duration of less than 5.5 days 3.

Clinical Presentation

• The common clinical manifestations of dengue fever include fever and myalgia, observed in 100% and 95.3% of the patients, respectively 2.
• Other clinical manifestations include bradycardia, pleural effusion, and ascites, found in 46.15%, 20.7%, and 15.3% of patients, respectively 2.

Diagnosis and Management

• Patients presenting with fever, hemorrhagic symptoms, or signs of plasma leakage should be promptly suspected, timely diagnosed, and managed on the grounds of dengue fever 2.
• Ultrasonography is an ideal non-invasive investigation to detect plasma leakage and area-specific hematocrit values are useful as evidence of plasma leakage 4.