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==Overview==
==Overview==
The typical signs of Dengue Fever include a high [[fever]] with no localizing source of infection on physical examination.  Occasionally [[petechia]] are present.  The physical examination in Dengue fever should be directed toward identifying warning signs that the patient has or may develop severe disease warranting in-hospital observation and/or intensive treatment.  These warning signs include tachycardia, [[postural hypotension]], a [[narrow pulse pressure]] (<20 mm Hg) and / or frank [[hypotension]] could indicate intravascular volume depletion due to either [[dehydration]] or capillary leak; [[petechia]], [[lethargy]], [[restlessness]], [[mucosal bleeding]], [[pleural effusion]], [[ascites]], [[hepatomegaly]], [[abdominal tenderness]] and [[pedal edema]].<ref name=WHO2009>{{cite web | title = Dengue: guidelines for diagnosis, treatment, prevention and control | url = http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf?ua=1 }}</ref>


==Physical Examination==
==Vital Signs==
===Pulse and Blood Pressure===
[[Tachycardia]], [[postural hypotension]], a [[narrow pulse pressure]] (<20 mm Hg) and / or frank [[hypotension]] could indicate intravascular volume depletion due to either [[dehydration]] or capillary leak.  The presence of any of the above is a warning sign of severe disease, and the patient should be hospitalized for observation.
 
===Urine Output===
If the patient is not urinating at least every 6 hours, this may reflect intravascular volume depletion due to capillary leak, and the patient should be observed for the development of severe disease.
 
==Skin==
If the patient has poor perfusion, the skin may be [[cold and clammy]].
 
[[Erythema]] of face, maculopapular [[rash]] and [[Petechiae]] may be present.<ref name="pmid20418984">{{cite journal| author=Thomas EA, John M, Kanish B| title=Mucocutaneous manifestations of Dengue fever. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 79-85 | pmid=20418984 | doi=10.4103/0019-5154.60359 | pmc=PMC2856380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418984  }} </ref>  The [[tourniquet test]] can used to elicit petechia.  A blood pressure cuff is applied and inflated to a point between the [[systolic]] and [[diastolic]] [[blood pressure]]s for five minutes.  The test is positive if there are more than 20 [[petechiae]] per square inch (a petechia is  a small red or purple spot on the body, caused by a minor hemorrhage).


<gallery>
<gallery>
Image:Denguerash.jpg|The above picture is a [[rash]] typically associated with Dengue fever.
Image:Denguerash.jpg|The above picture is a [[rash]] typically associated with Dengue fever. Source: CDC
</gallery>
</gallery>


The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with [[thrombocytopenia]] and relative [[leukopenia]].
==Mental Status==
[[Lethargy]] and [[restlessness]] are warning signs that the patient should be monitored for the development of severe disease.
 
==HEENT==
* [[Mucosal bleeding]] is a warning sign that the patient may have [[thrombocytopenia]], and should be monitored for the development of severe disease.
* Pharyngeal inflamation
* Retinal hemorrhage may occur.<ref name="pmid18617754">{{cite journal| author=Loh BK, Bacsal K, Chee SP, Cheng BC, Wong D| title=Foveolitis associated with dengue Fever: a case series. | journal=Ophthalmologica | year= 2008 | volume= 222 | issue= 5 | pages= 317-20 | pmid=18617754 | doi=10.1159/000144074 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617754  }} </ref>


There exists a [[World Health Organisation|WHO]] [http://www.who.int/csr/resources/publications/dengue/Denguepublication/en/index.html definition of dengue haemorrhagic fever] that has been in use since 1975; all four criteria must be fulfilled:
==Lungs==
# [[Fever]]
*[[Pleural effusion]] is a warning sign the capillary leak may be occurring and that the patient should be monitored for the development of severe disease.
# [[Bleeding|Haemorrhagic]] tendency (positive [[tourniquet test]], spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody [[diarrhea]])
# [[Thrombocytopenia|Thrombocytopaenia]] (&lt;100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
# Evidence of plasma leakage ([[hematocrit]] more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, [[pleural effusion]], [[ascites]], hypoproteinaemia)


'''Dengue shock syndrome''' is defined as dengue haemorrhagic fever plus:
==Abdomen==
*Weak rapid pulse,
*[[Abdominal pain]] or tenderness are warning signs and the patient should be monitored for the development of severe disease.
*Narrow pulse pressure (less than 20 mm Hg)
*[[Liver enlargment]] >2 cm is a warning signs and the patient should be monitored for the development of severe disease.
or,
*[[Ascites]] is a warning sign and the patient should be monitored for the development of severe disease.
*Hypotension for age;
*Cold, clammy skin and restlessness.


[[Serology]] and [[PCR]] (polymerase chain reaction) studies are available to confirm the diagnosis of dengue if clinically indicated.
==Extremities==
*[[Pedal edema]] or evidence of fluid accumulation is a warning sign and the patient should be monitored for the development of severe disease.


==References==
==References==
{{Reflist|2}}
 
{{reflist|2}}
 
[[Category:Needs content]]
[[Category:Biological weapons]]
[[Category:Flaviviruses]]
[[Category:Hemorrhagic fevers]]
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[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
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[[Category:Hematology]]
[[Category:Cardiology]]
[[Category:Gastroenterology]]

Latest revision as of 21:16, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The typical signs of Dengue Fever include a high fever with no localizing source of infection on physical examination. Occasionally petechia are present. The physical examination in Dengue fever should be directed toward identifying warning signs that the patient has or may develop severe disease warranting in-hospital observation and/or intensive treatment. These warning signs include tachycardia, postural hypotension, a narrow pulse pressure (<20 mm Hg) and / or frank hypotension could indicate intravascular volume depletion due to either dehydration or capillary leak; petechia, lethargy, restlessness, mucosal bleeding, pleural effusion, ascites, hepatomegaly, abdominal tenderness and pedal edema.[1]

Vital Signs

Pulse and Blood Pressure

Tachycardia, postural hypotension, a narrow pulse pressure (<20 mm Hg) and / or frank hypotension could indicate intravascular volume depletion due to either dehydration or capillary leak. The presence of any of the above is a warning sign of severe disease, and the patient should be hospitalized for observation.

Urine Output

If the patient is not urinating at least every 6 hours, this may reflect intravascular volume depletion due to capillary leak, and the patient should be observed for the development of severe disease.

Skin

If the patient has poor perfusion, the skin may be cold and clammy.

Erythema of face, maculopapular rash and Petechiae may be present.[2] The tourniquet test can used to elicit petechia. A blood pressure cuff is applied and inflated to a point between the systolic and diastolic blood pressures for five minutes. The test is positive if there are more than 20 petechiae per square inch (a petechia is a small red or purple spot on the body, caused by a minor hemorrhage).

Mental Status

Lethargy and restlessness are warning signs that the patient should be monitored for the development of severe disease.

HEENT

  • Mucosal bleeding is a warning sign that the patient may have thrombocytopenia, and should be monitored for the development of severe disease.
  • Pharyngeal inflamation
  • Retinal hemorrhage may occur.[3]

Lungs

  • Pleural effusion is a warning sign the capillary leak may be occurring and that the patient should be monitored for the development of severe disease.

Abdomen

  • Abdominal pain or tenderness are warning signs and the patient should be monitored for the development of severe disease.
  • Liver enlargment >2 cm is a warning signs and the patient should be monitored for the development of severe disease.
  • Ascites is a warning sign and the patient should be monitored for the development of severe disease.

Extremities

  • Pedal edema or evidence of fluid accumulation is a warning sign and the patient should be monitored for the development of severe disease.

References

  1. "Dengue: guidelines for diagnosis, treatment, prevention and control" (PDF).
  2. Thomas EA, John M, Kanish B (2010). "Mucocutaneous manifestations of Dengue fever". Indian J Dermatol. 55 (1): 79–85. doi:10.4103/0019-5154.60359. PMC 2856380. PMID 20418984.
  3. Loh BK, Bacsal K, Chee SP, Cheng BC, Wong D (2008). "Foveolitis associated with dengue Fever: a case series". Ophthalmologica. 222 (5): 317–20. doi:10.1159/000144074. PMID 18617754.