Recognising the 7 Warning Signs of Dengue Fever & What to Do

Dengue fever (break-bone fever) is a viral infection that spreads to people through the bite of an infected Aedes species mosquito, which includes Ae. aegypti or Ae. albopictus. It is a disease that continues to pose a global health threat.

So, why should we be worried about dengue fever? Dengue fever is a systemic illness that can have a profound effect on vital organs, including the liver, abdominal region, gall bladder, and eyes. While many dengue infections are mild, severe cases can lead to a wide range of symptoms that are life-threatening if left untreated.

In this article, we will explore seven warning signs of dengue fever, delving into the symptoms that signal a potential escalation to severe dengue.

Dengue fever statistics

The World Health Organisation (WHO) reports dengue fever to be an endemic in more than 100 countries and is especially prevalent in tropical and sub-tropical climates around the world, including Southeast Asia, the Americas, and the Pacific Islands. In recent decades, there has been a significant surge in dengue cases around the world. Data from the Centers for Disease Control and Prevention (CDC) reveals that at least 400 million people get infected with dengue across the globe each year, of which 40,000 die from severe dengue.

In Malaysia, dengue poses a significant public health concern due to its climate and regular flooding, making it conducive for Aedes mosquitoes to thrive in stagnant water. According to the Malaysian Ministry of Health’s Deputy Director-General, the cumulative number of dengue cases reported from January – April 2023 is 33,325 compared to 10,954 in the corresponding period last year, an increase of 204.2%. The statistic is alarming. As the weather is expected to get warmer towards the end of the year due to the El Nino phenomenon, we may see a rise in dengue cases.

What are the 3 phases of dengue?

Dengue fever typically progresses through different phases, each with its own set of symptoms and implications for the patient's health. The disease begins abruptly after a typical incubation period of 5 – 7 days, and is followed by 3 phases: high fever (febrile), critical, and recovery (convalescent).

Phase 1: High fever (febrile) phase

This is the initial phase, characterised by a sudden onset of symptoms, especially a sudden high-grade fever of around 40°C that usually lasts 2 to 7 days. The fever pattern is typically biphasic or saddleback, which means that it breaks and then returns for 1 or 2 more days. This first phase of dengue is also associated with headache, rash, and in some cases, nausea and vomiting.

Phase 2: Critical phase

If the disease worsens, dengue patients will progress into the critical phase. The onset of phase 2 typically lasts 24 – 48 hours and is heralded by a significant decline in platelet count in the patient’s blood. This is the period when those who develop severe disease will become critically ill, and in some cases, there may be organ dysfunction and severe bleeding.

Phase 3: Recovery (convalescent) phase

The period beyond 7 days after symptom onset is referred to as the recovery phase. The patient should start to regain lost functions, regain appetite, and health conditions should begin to progressively get better at this point. However, prolonged fatigue and weakness is expected.

7 warning signs of dengue fever you should not ignore

Understanding the warning signs of dengue fever is critical for early detection and prompt medical intervention. Here are seven primary symptoms to watch out for.

Warning sign 1: Sudden high fever

High fever is one of the hallmarks of dengue. During the febrile stage, dengue patients typically experience a sudden and high fever with temperatures spiking to 40°C or more. This is often accompanied by severe chills and sweating. The abruptness of the fever, coupled with its severity, makes it a critical indicator for the disease.

Warning sign 2: Unprecedented rash

About 2 to 5 days after the onset of fever, a skin rash that is characterised by small, red or pink pinhead-like spots may appear across the body – usually around the arms, legs, and torso. Patients may also experience increased skin sensitivity, itchiness, and general discomforts. The rash can sometimes be mistaken for other skin conditions like allergies, and since rash isn’t exclusive to dengue, it can often lead to misdiagnosis without proper diagnostic tests.

Warning sign 3: Bleeding tendencies

Bleeding tendencies represent one of the most concerning and life-threatening symptoms associated with dengue fever. During the critical phase, dengue patients are at an increased risk of experiencing bleeding from various sources within the body, including the nose, gums, and gastrointestinal tract. In some cases, bleeding under the skin is also observed, which looks more like bruises.

Severe bleeding occurs as a result of a drop in platelet count. As platelets play a crucial role in blood clotting and coagulation, a significant decrease in platelet count can result in uncontrolled and profuse bleeding, posing a significant risk to the patient’s health and necessitates immediate medical intervention. Early recognition is paramount in managing this dangerous warning sign.

What is a normal platelet count?

The normal platelet count levels of a typical healthy individual is between 150,000 – 450,000 per microliter of blood. The Adult Dengue Platelet Study, conducted by researchers from Malaysia and Singapore in 2017, reported that approximately 80% - 90% of dengue patients will have platelet count levels below 100,000, while 10% - 20% will see dangerous platelet count levels of <20,000.

Warning sign 4: Severe headaches and body aches

The febrile phase brings intense headaches and body aches, which are often described by dengue patients as debilitating. Intense headaches that leave a pulsating ache and occur repeatedly are commonly experienced. In most cases, analgesics cannot prevent them from coming.

Severe body aches is also among the most common signs of dengue. As the infection proliferates into the muscles and causes inflammation, excruciating pain is felt across the body – especially in the muscles and joints, which is why the disease is aptly named “break-bone fever”.

Warning sign 5: Eye pain and complications

People suffering from dengue fever experience varying degrees of eye discomforts. This symptom often accompanies the severe headaches and muscle aches. While some patients experience mild discomforts at the back of their eyes, the disease can lead to more severe ocular complications, including vision problems, hemorrhages, eye swelling, and in rare cases, even blindness.

Warning sign 6: Severe abdominal discomfort

During the febrile phase of the illness, dengue patients may experience severe abdominal discomfort, which can range from light cramping sensations to sharp, intense pain. This symptom can be mistaken for other gastrointestinal issues, which can delay the correct diagnosis of dengue. In severe cases, abdominal pain can escalate to a critical stage and lead to internal bleeding. Therefore, dengue patients experiencing abdominal pains should seek immediate medical attention to ensure proper diagnosis.

Warning sign 7: Recurrent nausea, vomiting, and diarrhea

As the disease is known to affect the gastrointestinal region and weaken overall gut health, it comes as no surprise that nausea, vomiting, diarrhea, and tenderness in the abdominal region are some of the symptoms experienced by dengue patients. In extension, patients also observe loss of appetite and difficulty retaining food or liquids, resulting in dehydration. While these symptoms are not uncommon in most illnesses, they serve as significant indicators of dengue.

When should you seek medical assistance?

In the recovery phase of dengue fever, various symptoms gradually subside. While recovery is a gradual process, there are noticeable signs that someone is on the path to recovery.

Signs of dengue recovery include:

• Overall improvement of symptoms
• Fever subsides and body temperature returns to normal
• Reduced head, joint, and muscle pains and discomfort
• Blood pressure and pulse rate rise
• Improved appetite and ability to retain food and fluids
• Increased urine output signifying the body slowly rehydrating
• Platelet count rising to normal levels (detected through blood tests)

Diagnosing dengue fever can be difficult as its signs and symptoms are easily confused with other vector-borne diseases like malaria, Zika, and Japanese encephalitis. If you are unsure and experience the warning signs, it is essential that you seek medical advice to receive early and accurate diagnosis so that interventions can be taken. Your medical advisor will be able to diagnose dengue infection by employing diagnostic methods such as clinical assessments, laboratory tests including blood tests, and dengue test kits.

Diagnosing dengue fever using self-test kits

The availability of dengue test kits that are designed for home use have brought about the potential for self-testing. The safety of self-test kits can vary and is largely dependent on factors including:

• Quality and accuracy of the test kits;
• The user’s ability to follow instructions correctly; and
• Proper handling and execution of the testing process.

It is important to exercise caution when using self-test kits, be aware of their limitations, and understand the consequences of misdiagnosis. While convenient, seeking professional confirmation of test results is advisable.

Dengue fever can be life-threatening. This makes early and accurate diagnosis critical to facilitate timely medical intervention and reduce the risk of complications and fatality. Stay informed about dengue-related news with MyHealth KKM or iDengue portal and take the necessary steps to protect yourself and the people around you from the threat of dengue.

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