How is non-severe dengue diagnosed?
Dengue is often not diagnosed at all. When symptoms are mild or non-existent you may never know that you have had the infection.
Symptomatic dengue can mimic many other illnesses. Some of these illnesses are more common in returning travellers than others. If you have been in the middle of a dengue outbreak then you will know that dengue is a possible cause of your symptoms, and you must mention this to your doctor.
Most doctors in the UK will not have treated cases of dengue: only about 400 cases a year are diagnosed in the UK. Your doctor will usually want to test you for malaria if you have returned from a malarial zone with a high temperature (fever). The malaria blood test will not detect dengue, so the doctor will need to test you specifically for dengue. Dengue resembles so many other conditions that the only way to make the diagnosis certainly is through blood tests.
How is severe dengue diagnosed?
Even severe dengue can be confused with several other conditions, although there are fewer possibilities and you will be tested for all of them.
If you are suspected of having dengue then blood tests will be performed to look for signs of the virus in your blood. Doctors can also look for antibodies in the blood suggesting recent or previous dengue. Blood tests will also be used to check on how severe the infection is.
How is non-severe dengue treated?
There is no specific treatment for dengue. If your symptoms are mild then paracetamol is helpful for the headache and aching muscles which are typical of dengue.
How is dengue with warning symptoms treated?
If you are diagnosed with dengue and go on to develop some of the warning symptoms then you are likely to be kept in hospital for observation until things settle down, in case you develop severe dengue.
How is severe dengue treated?
Patients with severe dengue can quickly become severely unwell - close monitoring is needed. Treatment will include:
- Fever control with paracetamol, tepid sponging and fans.
- Intravenous fluids which are likely to be needed, as severe dengue causes fluid to leak from veins and arteries into the surrounding tissues. You will be closely monitored, with regular blood tests.
- In very severe cases, intensive care may be needed to support vital organs whilst the disease runs its course.
- Treatment for secondary bacterial infections, which commonly occur.
- Blood products, which may also be needed.
What are the complications of dengue?
There are usually no complications - an attack of dengue is most commonly like having the flu. When the patient's appetite returns this is a good sign of recovery, although tiredness and depression can last for some weeks after recovery.
Severe dengue is a life-threatening infection. Around 1 in 100 patients with dengue will die, but around 5 in 100 of patients with severe dengue will die (the figure is much higher if the patient is not treated in hospital).
Most severe dengue and most deaths occur in children aged less than 15 years; however, in recent years the numbers of deaths in young adults has increased.
Further reading and references
Dengue and severe dengue; World Health Organization, July 2016
Dengue Clinical Guide - Treatment Algorithm; Centers for Disease Control and Prevention
Vasilakis N, Weaver SC; The history and evolution of human dengue emergence. Adv Virus Res. 200872:1-76. doi: 10.1016/S0065-3527(08)00401-6.
Dengue fever; National Travel Health Network and Centre (NaTHNaC)
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