Not an ID expert, but have dealt with hundreds of Dengue patients in internal medicine job a few years ago.

Not an ID expert, but have dealt with hundreds of Dengue patients in internal medicine job a few years ago.

The following were my observations:

  1. In an epidemic of Dengue, since the vast majority of fevers are due to it, plus there's no specific medicine, there seems to be no point in checking for Dengue antigen. (Antibody test is more a waste as it simply tells that you had it; not that you can't have it again)
  2. Symptoms are common: fever, headache is usual. Extreme body ache and weakness is typical.

Though these are non specific, take it as Dengue, don't waste money on getting it tested.

  1. Since Malaria season overlaps with Dengue, if the fever is high grade with rigors, or nausea, abdominal pain, MP ICT may be checked. Treatment for malaria is available and can help limit the disease.
  2. Except a few serious ones, all Dengue cases can be managed with rest, paracetamol.

Ensuring good fluid intake is vital, oral is fine, take IV only if 2.5+ liters can't be managed by mouth.

NSAIDs can be taken in extreme pains if paracetamol not enough. They have a theoretical disadvantage of precipitating GI bleeding if platelets are lower than 30,000 (which can only be tested).

  1. One strong observation is the symptoms going hand in hand with the platelet (and WCC) count. Once disease gets under control, both improve. Conversely in severe worsening myalgias, weakness, one can expect platelets to be receding; this may be a case for checking CBC. Similarly once 25,0000 platelet count rises to 35,000 even the next day, there may be no further need to keep repeating it till normal.
  2. The biggest public, and doctors, concern is *platelet* transfusion. People are frenzied and demand transfusion from doctors. Similarly doctors too, advise transfusion unnecessarily in anxiety more than science.

It has been proven repeatedly that there is NO need to transfuse platelets in counts up to 5,000. The only exception is bleeding, in which case counts don't matter; transfuse even at 50k. In fact admit and manage.

  1. If a Dengue, or a suspected Dengue shows sinister signs: drowsiness, very high fever (104+), fits, low urine output, dizziness, or rapid respiratory rate, take him to hospital immediately. Dengue shock is life threatening and can be rapidly fatal.

Fortunately extremely low incidence, and almost all cases can be observed at home as per above principles.