India carries one of the highest dengue burdens globally. Most dengue infections are self-limiting and resolve within seven to ten days. The danger lies in the critical phase typically days four to six when plasma leakage (fluid shifting out of the bloodstream), bleeding from low platelet counts and organ impairment converge rapidly. Severe dengue can be life threatening when not recognised in time. At CARE Hospitals, the dengue emergency pathway begins with warning sign identification and escalates to ICU-level fluid management when needed.

Common Causes of Dengue

Dengue is caused by a flavivirus with four serotypes (DENV-1 to DENV-4). Understanding transmission and risk factors enables prevention and early recognition:

• Mosquito: Bite of an infected Aedes aegypti mosquito the primary vector; Aedes albopictus is a secondary vector; both are day-biting mosquitoes active in early morning and late afternoon
• Previous Dengue Infection: The dengue virus has four different serotypes. A person who has had dengue before may be at higher risk of developing severe dengue if infected with a different serotype in the future.
• Urban environments: Aedes mosquitoes breed in stagnant water in flower pots, tyres, coolers and blocked gutters; crowding and poor water storage sustain transmission
• Monsoon season: Transmission peaks July to November in India
• No person-to-person spread: Dengue requires a mosquito vector and blood transfusion from an infected donor is a rare route.

Signs and Symptoms of Dengue

Dengue progresses through febrile, critical, and recovery phases. Warning signs at the transition to the critical phase must be identified promptly:

• Febrile phase (days one to three): Sudden high fever (39 to 40°C), severe headache, pain behind the eyes, myalgia and arthralgia (muscle and joint pain), facial flushing and a transient rash
• Critical phase (days four to six): Fever may drop that falsely suggesting recovery; plasma leakage begins and haematocrit (blood concentration) rises. Dengue haemorrhagic fever (DHF) develops in some patients and result in spontaneous bleeding, petechiae and thrombocytopenia (platelet count below 100,000 per microlitre).
• Warning signs: Abdominal pain; persistent vomiting; fluid accumulation (ascites or pleural effusion); mucosal bleeding; lethargy or restlessness; liver enlargement above 2 cm; rising haematocrit with falling platelet count
• Dengue shock syndrome (DSS): Severe plasma leakage causing circulatory failure including narrow pulse pressure, rapid weak pulse, cold clammy skin and altered consciousness
• Recovery phase (days seven to ten): Fluid returns to the bloodstream; risk of fluid overload if IV fluids continue; rash may reappear; rising platelet count signals recovery.

First Aid for Dengue (Before Reaching Hospital)

First aid is supportive and the goal is to maintain hydration and monitor for warning signs:

• Maintain hydration: Encourage water, ORS, coconut water and diluted fruit juice. The WHO recommends more than 2 litres per day for adults. Dehydration accelerates the transition to shock.
• Manage fever safely: Give paracetamol to reduce fever and pain. Never give aspirin, ibuprofen, or other NSAIDs as they inhibit platelet function, increase bleeding risk and can cause gastric haemorrhage in dengue thrombocytopenia (low platelets).
• Rest: Physical exertion raises bleeding risk. Complete rest during the febrile and critical phases is essential.
• Monitor daily for warning signs: From day four, check daily for abdominal pain, vomiting, bleeding, unusual fatigue or reduced urine.
• Go to the hospital immediately if warning signs appear: Warning signs indicate the critical phase which means the window for safe oral management is closing, and IV fluid therapy may be needed within hours.

When to Seek Emergency Care for Dengue

These signs indicate severe dengue and require immediate hospital assessment:

• Abdominal pain or tenderness 
• Persistent vomiting - three or more episodes in one hour
• Bleeding from the gums, nose, or gut (blood in vomit or black tarry stools)
• Petechiae or bruising appearing without injury
• Rapid breathing or difficulty breathing 
• Cold, clammy, or mottled skin
• Weak rapid pulse
• Dizziness on standing 
• Reduced urine output - less than six hours between urination indicates dehydration or early organ impairment
• Altered consciousness, extreme restlessness, or unusual drowsiness
• Platelet count below 20,000 per microlitre on blood test.

Emergency Treatment at the Hospital for Dengue

Hospital management focuses on fluid balance, monitoring and detecting complications as there is no specific antiviral drug for dengue:

• Diagnosis and monitoring: The NS1 antigen test detects the virus antigen from day one to five, and IgM and IgG antibodies confirm infection after day five. Daily full blood count monitors haematocrit, platelet count and white cell count.
• Fluid management: Precise IV fluid replacement guided by clinical monitoring like pulse, blood pressure, urine output and haematocrit. Isotonic crystalloid, like 0.9% saline or Ringer's lactate solution is titrated and given. Over-resuscitation causes pulmonary oedema (fluid in the lungs) so fluids are tapered as platelet count rises.
• Management of dengue shock: 10 to 20 ml/kg isotonic crystalloid boluses over 15 to 30 minutes. If haematocrit falls without improvement colloid is added. ICU admission with invasive monitoring is required for persistent shock.
• Platelet transfusion: Indicated only for active bleeding or prophylactically below 10,000 per microlitre. Transfusing above this threshold provides no benefit and risks fluid overload.
• Monitoring for organ impairment: Liver function, renal function and coagulation are monitored. Myocarditis (heart muscle inflammation) and encephalitis (brain inflammation) are rare but serious complications requiring specialist review.

What Not to Do

These actions worsen illness or mask deterioration.

• Do not take aspirin, ibuprofen, or any NSAID 
• Do not take antibiotics as dengue is a viral illness
• Do not stop drinking when the fever drops 
• Do not request or accept a platelet transfusion without a clinical indication 
• Do not assume recovery when the fever breaks because the most dangerous phase begins as the fever subsides so monitor through to day seven.

Conclusion

Dengue is manageable but severe dengue and dengue shock can become life threatening when warning signs are missed. At CARE Hospitals, patients are stratified using the WHO dengue classification on admission, monitored with daily blood counts and haematocrit and escalated to IV fluid management and ICU care at the first sign of warning signs or haemodynamic compromise.

FAQs

1. What are the early symptoms of dengue?

Sudden high fever (39 to 40°C), severe headache, retro-orbital pain (pain behind the eyes), muscle and joint aches (the source of the name breakbone fever), facial flushing, and an early transient rash typically appearing within four to seven days of an infected mosquito bite.

2. When should dengue be treated as an emergency?

When warning signs like abdominal pain, persistent vomiting, mucosal bleeding, petechiae, rapid breathing, cold or clammy skin, reduced urine output or altered consciousness appear immediately contact emergency services. These indicate the onset of the critical phase requiring IV fluid therapy and hospital monitoring.

3. What causes platelet counts to fall in dengue?

The dengue virus directly infects the bone marrow cells that produce platelets and promotes immune mediated platelet destruction. This results in thrombocytopenia (low platelet count) that increases the risk of spontaneous bleeding.

4. What foods and drinks are recommended during dengue?

Recommended foods and drinks are:

• High fluid intake like ORS, coconut water, diluted fruit juice and soups 
• Easily digestible foods like rice, toast, bananas and dal
• Papaya leaf extract (shown in some studies to promote platelet recovery). 
• Avoid spicy, fatty, or hard-to-digest foods during the illness.

5. What are the warning signs of severe dengue?

Warning signs are:

• Abdominal pain or tenderness
• Persistent vomiting
• Bleeding from any mucosal surface
• Petechiae or bruising
• Pleural effusion or ascites
• Cold clammy skin with rapid weak pulse
• Restlessness or drowsiness
• A rapid fall in platelet count alongside a rising haematocrit.

6. How long does dengue recovery take?

The febrile phase lasts three to four days; the critical phase days four to six; the recovery phase begins around day seven and most patients are fully recovered by day ten. Fatigue and weakness can persist for two to four weeks in severe cases.

7. Is dengue contagious from person to person?

No dengue requires a mosquito vector and direct person-to-person spread does not occur. However blood transfusion and organ transplantation from an infected donor are rare routes, but casual contact, coughing and sharing food carry no transmission risk.

CARE Medical Team