Dengue Fever: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate dengue fever:

Symptoms of dengue fever range from mild flu-like symptoms to serious complications such as hemorrhages (bleeding) or severe shock syndrome. Symptoms of classic dengue fever (DF).

  • High fever (up to 40 °C, 48-96 hours) with a brief drop in fever on day 3-4 (often, but not always, biphasic/”proceeding in two phases”).
  • Erythema (extensive reddening of the skin), especially on the face and chest, which can be pushed away; often with white dermographism (skin reaction visible a few seconds to minutes after moderately strong mechanical irritation (e.g., by a wooden spatula))
  • Exanthema (skin rash), maculopapular (patchy and with papules, i.e., vesicles):
    • Beginning on the dorsum of the hands and feet and then spreading to the proximal extremities and trunk (truncal), sparing the face [50% of patients have this after transient defever].
    • Nappes-claires-like recesses of unaffected skin (“islands of white in a sea of red”) are characteristic.
  • Mild bleeding signs (petechiae/punctate skin hemorrhages, bleeding from puncture sites).
  • Chills
  • Headache (frontal and retroorbital (“behind the eye socket”) headache/retrobulbar pain).
  • Conjunctivitis (conjunctivitis)
  • Photophobia (photophobia)
  • Back pain
  • Myalgia (muscle pain) and arthralgia (joint pain; “bone-crushing aspect”; “breakbone fever”/bone-crushing fever)
  • Generalized lymphadenopathy (lymph node enlargement) (esp. nuchal/in the neck region).
  • Splenomegaly (splenomegaly).
  • Conjunctivitis (conjunctivitis)
  • Bradycardia – too slow heartbeat: < 60 beats per minute.
  • Hypotension – low blood pressure
  • Transaminase increase – increase in liver enzymes [moderately increased].
  • Thrombocytopenia – decrease in platelets (thrombocytes) in the blood.
  • Lymphopenia – decrease in lymphocytes (white blood cells, which are divided into T and B lymphocytes) in the blood.

The convalescence is usually several weeks. Symptoms of mild atypical dengue fever.

  • Similar to classic dengue fever, but milder and short duration of three (to five) days maximum.

In rare cases, hemorrhages (bleeding) and shock can occur as complications already in a first infection – or in a second infection (there are 4 dengue serotypes). Symptoms of dengue hemorrhagic fever (DHS).

  • Rapid rise in fever
  • Headache
  • Nausea / vomiting
  • Dyspnea (shortness of breath)
  • Petechiae – punctate bleeding of the skin.
  • Purpura – small-spot capillary bleeding in the skin, subcutis or mucous membranes (skin hemorrhage).
  • Epistaxis (nosebleed)
  • Gastrointestinal bleeding (gastrointestinal bleeding).
  • Cerebral hemorrhages
  • Pneumonia (inflammation of the lungs)
  • Thrombocytopenia (reduction in platelets; platelet drop to < 100,000/µl → inpatient admission required).

Symptoms of severe dengue fever.

  • Dengue fever +
    • Capillary leak syndrome (synonym: Clarkson’s syndrome) – severe disease with generalized edema due to increased permeability of capillary vessels; subsequently, occurrence of severe hypovolemic shock (volume deficiency shock) associated with arterial hypotension (high blood pressure) with hemoconcentration (thickening of blood)
    • Dengue shock syndrome (DSS; see below).
    • Adult (Acute) Respiratory Distress Syndrome (ARDS) – acute respiratory failure in a previously lung-healthy individual.
    • Effusions
    • Or severe bleeding
    • Or organ dysfunction (e.g., transaminases > 1,000 IU/l; heart failure; impaired consciousness).

Symptoms of dengue shock syndrome (DSS; synonym: dengue vascular permeability syndrome (DVPS)) [2nd phase]

  • All DHS criteria (see above) + signs of shock:
    • Rapid, weak pulse with small pulse amplitude (< 20 mmHg).
    • Or hypotension (low blood pressure)
    • Cold sweats
    • Restlessness
  • Bleeding
  • Cardiovascular failure
  • Laboratory: increase in hematocrit (proportion of red blood cells (RBCs) in the volume of blood), thrombocytopenia (decreased number (<150,000/µl) of platelets (thrombocytes) in the blood), and hypoproteinemia (decreased concentration of total protein in blood plasma (<60 g/L)).

The lethality (mortality relative to the total number of people suffering from the disease) is up to 44%. Symptoms of convalescence [3rd phase].

Warning signs (red flags)

Warning signs of a possible complicated course are:

  • Mucosal bleeding
  • Abdominal pain (abdominal pain)
  • Persistent vomiting
  • Hepatomegaly (enlargement of the liver)
  • Edema (water retention)
  • Proteinuria (increased excretion of protein in the urine).
  • Lethargy and restlessness