Dengue fever physical examination

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

Overview

The classic picture of Dengue Fever includes a high fever with no localizing source of infection on physical examination, with petechia being present occasionally. The physical examination in Dengue fever should be directed toward identifying signs that the patient has severe disease warranting admission or in-hospital observation.

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

Patients who are triaged to home management should urinate at least every 6 hours.

Skin

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

Petechiae may be present. The tourniquet test can used to cause petechia.

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  The above picture is a rash typically associated with Dengue fever.

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 signs that the patient may have thrombocytopenia, and should be monitored for the development of severe disease.

Lungs

• Pleural effusion is a warning sign the capillary leak may be occurring and that the patient should be monitored.

Abdomen

• Abdominal pain or tenderness are warning signs that the patient should be monitored.
• Liver enlargment >2 cm is a warning signs that the patient should be monitored.
• Ascites is a warning signs that the patient should be monitored.

Extremities

• Pedal edema or evidence of fluid accumulation