What is the incubation period of dengue?
The incubation period of dengue is usually 4-10 days.
What are the symptoms of non-severe dengue?
Dengue is a flu-like illness, and patients experience headache, muscle pain and high temperature (fever). There is often a rash, which usually (but not always) blanches on pressure. Where symptoms occur, the illness typically begins with a sudden, high fever (39.5-41°C/104°F). The fever comes and goes over about two days. Other symptoms include:
- Severe headache.
- Headache behind the eyes.
- Muscle and joint pains.
- Feeling sick (nausea), being sick (vomiting) - particularly in children.
- Swollen glands.
- Rash, which usually pales when pressed with a glass.
- Symptoms which usually last for 2-7 days.
A measles-like rash often occurs. This may be a blotchy red rash which may run together so that it looks like 'islands of white in a sea of red'. Small red spots that do not disappear when the skin is pressed may also appear.
In non-severe dengue the fever then resolves and the patient recovers. In dengue with warning signs another 'phase' of the disease develops.
What are the symptoms of dengue with warning signs?
Warning signs may develop 3-7 days into the illness. The temperature often falls but those affected may experience:
- Severe tummy pain.
- Persistent vomiting, sometimes with blood in the vomit.
- Fast breathing.
- Bleeding gums.
- Feeling of physical restlessness.
- Purple spots or blotches on the skin, which may not fade when pressed with a glass.
- Nosebleeds (epistaxes).
- Bleeding gums.
- Tummy pain.
- Heavier than usual periods.
- Low blood pressure and slow heart rate.
- Swollen glands.
These symptoms are considered warning signs. This means that they increase the chance that the affected person may progress to severe dengue. Patients with warning signs need regular monitoring.
What are the symptoms of severe dengue?
People with severe dengue are very sick, with shock, collapse and, often, bleeding. The symptoms seen in dengue with warning signs may occur and may be more severe. Facial swelling is sometimes seen and there may be problems with vision. They may be shocked and collapsed and they may experience problems of the heart, liver, lungs and circulation.
Severe dengue is a life-threatening illness.
What is recovering from dengue like?
Most cases of dengue end with a 'recovery phase'. Patients are often very itchy, and where there has been a rash the skin may peel. There may be a new rash, which may or may not blanch on pressing, and patients feel tired. Rarely, a fit (seizure) can occur.
What other conditions can mimic dengue?
Because dengue is a flu-like illness, any illness which can cause fever and aching can mimic dengue.
If you have travelled to a region where dengue is present and you develop a fever, then dengue is one possible cause. Other causes of fever in returning travellers include:
- Malaria (a common cause of fever in a sick returning traveller).
- Typhoid fever.
- Chikungunya virus.
- Yellow fever.
- Lyme disease.
- Other more rare haemorrhagic fevers - for example, Hantavirus, Ebola, and Lassa fever.
- New infection with HIV.
- Weil's disease (leptospirosis).
- Kawasaki disease.
This list is not complete; there are many other infections which can cause a fever with flu-like symptoms. Your doctor will want to talk about where you have been, what exposure you have had to biting insects, what immunity you already have, and exactly what your symptoms are in order to work out which conditions you are likely to have.
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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