Dengue Signs

(A note from the author of this web page:   As indicated above where it says "low platelets", red platelets are usually low in count when Dengue problems surface.  As announced on news broadcasts here, children and adults with low platelet counts are usually the ones that contract the disease while healthy individuals do not.  Foreigners who have relatives who do not eat and sleep properly in a relatively clean environment can intervene and introduce extra foods and vitamins that will ward off this life threatening disease.)

The diagnosis of dengue is typically made clinically, on the basis of reported symptoms and physical examination; this applies especially in endemic areas.^[1] Early disease can however be difficult to differentiate from other viral infections.^[3] A probable diagnosis is based on the findings of fever plus two of the following: nausea and vomiting, rash, generalized pains, low white blood cell count, positive tourniquet test, or any warning sign (see table) in someone who lives in an endemic area.^[2] Warning signs typically occur before the onset of severe dengue.^[5] The tourniquet test, which is particularly useful in settings where no laboratory investigations are readily available, involves the application of a blood pressure cuff for five minutes, followed by the counting of any petechial hemorrhages; a higher number makes a diagnosis of dengue more likely.^[5] Often, investigations are performed to exclude other conditions that cause similar symptoms, such as malaria, leptospirosis, typhoid fever, and meningococcal disease.^[3]

The earliest laboratory change is a low white blood cell count, which may then be followed by low platelets and metabolic acidosis.^[3] Plasma leakage may result in hemoconcentration (as indicated by a rising hematocrit), hypoalbuminemia, pleural effusions, or ascites.^[3] The demonstration of fluid on ultrasound may assist in the early identification of dengue shock syndrome,^[1][3] but is not widely available.^[1]