Infectious

Dengue Fever

ڈینگی بخار

Mosquito-borne viral illness (Aedes aegypti). Outbreaks occur yearly in Pakistan after the monsoon, peaking from September to November.

ICD-10: A90–A91
Source: General reference written by the assistant (not from the OPD book); needs clinical review
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

High fever for 2–7 days
Severe headache and pain behind the eyes
Muscle, joint and bone pain
Rash, mild bleeding (nose, gums)
Nausea and vomiting

Red flags Refer urgently if any are present

Persistent vomiting
Severe abdominal pain or tenderness
Bleeding from gums, nose, vomit or stool
Lethargy or restlessness
Fluid accumulation (ascites, pleural effusion)
Rapid fall in platelets with rising haematocrit around defervescence

Diagnosis

NS1 antigen in the first 5 days
Dengue IgM/IgG after day 5
CBC: falling platelets and WBC, rising haematocrit
Check liver enzymes, albumin and urea in admitted patients

Treatment

Step 1 of 4

Triage: group A, B or C

WHO 2009 classification adopted by provincial guidelines.

Group A: can drink, passing urine, no warning signs: home care
Group B: warning signs, comorbidity, pregnancy, infants, elderly, poor social circumstances: admit or observe
Group C: severe dengue (shock, severe bleeding, organ failure): emergency care

Step 2 of 4

Febrile phase: home care (group A)

Oral fluids: ORS, soup, lemon water, coconut water, 2.5–3 L/day for adults
Rest, tepid sponging
Daily review with CBC (platelets and haematocrit) until 48 h after fever settles
Return immediately if any warning sign develops

Prescription

Paracetamol (Acetaminophen)Analgesic / antipyretic

DoseAdult 500 mg–1 g every 6–8 h (max 4 g/day); child 10–15 mg/kg

Brands Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL) While febrile

Never use aspirin, ibuprofen or other NSAIDs

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

Oral Rehydration Salts (low-osmolarity WHO ORS)Rehydration

DoseFrequent small sips

Brands WHO low-osmolarity ORS sachet Throughout illness

Free ORS is stocked at government facilities and distributed by Lady Health Workers. Many private ORS brands exist; check the sachet states the WHO low-osmolarity formula.

Caution: Mix with the exact volume of clean water stated on the sachet; Discard made-up solution after 24 hours

Step 3 of 4

Critical phase: in hospital (group B and C)

Day 3–7, around defervescence, when plasma leakage occurs.

Monitor vitals, urine output and haematocrit every 4–6 h
Group B: oral fluids, IV crystalloid if unable to drink or haematocrit rising
Group C: immediate IV crystalloid bolus, reassess every hour, escalate per shock protocol
Give only the minimum IV fluid needed; reduce as leakage settles
Platelet transfusion is not indicated by count alone; reserve for major bleeding
Transfuse fresh whole blood or red cells for significant bleeding

Prescription

Ringer's lactate (Hartmann's solution)IV crystalloid

Dose5–7 mL/kg/h for 1–2 h, then reduce to 3–5, then 2–3 mL/kg/h by response; shock: 10–20 mL/kg bolus

Brands Generic / hospital supply 24–48 h of leakage

Caution: Monitor for fluid overload, especially in dengue critical-phase recovery

Step 4 of 4

Recovery phase

Stop IV fluids once leakage resolves, to avoid overload
Watch for fluid overload: breathlessness, puffy face, rising BP
Platelets recover on their own; no need for papaya leaf extract or supplements
Advise rest and return to normal activity gradually

Prevention

Remove stagnant water (coolers, tyres, flower pots) at least weekly
Mosquito nets/screens, repellents, long sleeves (Aedes bites in daytime)
Report clusters to the district health authority

Guideline sources

WHO Dengue: guidelines for diagnosis, treatment, prevention and control (2009)
WHO/TDR 2012 handbook for clinical management of dengue
Provincial Dengue Expert Advisory Group guidelines