Disease Description (Causes and Symptoms)
- Causes and pathophysiology: This is an acute viral disease caused by transmission of the dengue virus by vectors, primarily daytime-active forest mosquitoes found in tropical and subtropical regions. The virus has several serotypes, and in people with a previous infection, the immune response (interaction between antibodies) upon reinfection increases the risk of developing severe forms (dengue hemorrhagic fever/dengue shock syndrome).
- Main symptoms: After an incubation period of 3–14 days, symptoms include fever, headache (especially pain behind the eyes), muscle/joint pain (“breakbone fever”), rash, loss of appetite, nausea and vomiting, petechiae, gum bleeding, and others. Most cases improve within several days to 1 week, but the disease can progress to severe illness if bleeding or hemodynamic instability (hypotension or shock) occurs.
Treatment Methods
- Basic principles: As no specific antiviral medication has been established, conservative (supportive) treatment is the main approach.
- Outpatient/mild cases: Get sufficient rest and maintain hydration (oral rehydration solution). Acetaminophen (Tylenol) is recommended for fever reduction. Nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen) and aspirin should be avoided because of the risk of bleeding.
- Inpatient/severe case management:
- Hemodynamic monitoring and electrolyte management through aggressive fluid therapy (intravenous fluids).
- Oxygen therapy if necessary.
- If bleeding is severe or the patient is hemodynamically unstable, transfusion (red blood cells or plasma) and other measures may be performed — the indications and methods are determined by the inpatient treatment team.
- Even if thrombocytopenia is present, prophylactic transfusion is not generally recommended when there are no signs of bleeding (it may be considered in special situations, such as bleeding or before a procedure).
- Lifestyle management: Maintain fluid intake, get sufficient rest, and minimize exposure to mosquitoes outdoors (to prevent transmission to others).
- Precautions: Immediate emergency evaluation is necessary if high fever, persistent vomiting, severe abdominal pain, difficulty breathing, bruising, gum bleeding, bloody stools, dizziness, or signs of hypotension occur.
Outpatient Visit Checklist (Including Example Questions)
Items and records to prepare
- Recent travel history (especially to tropical or subtropical regions) and when you were bitten by mosquitoes
- Date symptoms began (date fever started) and symptom progression (temperature records and when bleeding symptoms began)
- List of medications currently being taken (including anticoagulants and antiplatelet drugs)
- Previous history of dengue infection or blood disorders
- Recent test results (if available) and allergy information
- Records of urine output, food intake, and fluid intake
Possible tests during an outpatient visit
- Blood tests: CBC (white blood cells/platelets), blood coagulation tests, and liver function tests
- If necessary, dengue antigen (NS1), PCR, and antibody (IgM/IgG) tests
Examples of items patients may prepare themselves
- The exact date the fever began and the highest body temperature
- Whether vomiting or diarrhea has occurred and bowel movement status
- Whether bleeding symptoms (bruising, gum bleeding, bloody stools, etc.) are present and when they occurred
General Example Questions to Ask a Doctor
- Could this medication (the medication I am currently taking) affect my dengue symptoms? Should I stop taking it?
- Given my condition, do I need hospitalization or intravenous fluid treatment?
- What fever-reducing medication should I use? Which medications should I avoid?
- What are the risks of complications and the prognosis?
- When is it appropriate to return to daily activities (such as exercise or work) after recovery?
Examples of Disease-Specific Questions
- I have had dengue before. Could these symptoms represent reinfection (or progression to severe disease)? What additional precautions should I take?
- I have recently noticed bleeding symptoms. How do you determine whether hospitalization or transfusion is necessary based on the platelet count?
(Note: Blood tests and clinical judgment by medical professionals are important early after symptoms begin. If symptoms suggesting severe disease occur, visit an emergency medical institution immediately.)