Dengue Fever in an Adult Male
Dengue fever is a mosquito-borne viral infection that can range from a mild febrile illness to severe disease with plasma leakage, shock, bleeding, or significant organ involvement. The illness typically progresses through febrile, critical and recovery phases, making close monitoring particularly important around the time of defervescence.
A falling platelet count alone does not define severe dengue. Clinical condition, haematocrit trends, evidence of plasma leakage, bleeding, and organ involvement must be assessed together. Early recognition of warning signs and appropriate fluid management can help prevent progression to severe disease.
Dengue management requires careful monitoring, adequate hydration, appropriate symptomatic treatment, and prompt recognition of clinical deterioration. Avoiding medications such as aspirin and NSAIDs is also important because of the risk of bleeding.
Patient Information
- Age/Sex: 32-year-old male
- Occupation: Business professional
- Presentation: Acute febrile illness
Chief Complaints
The patient presented with:
- High-grade fever for 4 days
- Severe headache
- Retro-orbital pain
- Generalised body ache
- Marked fatigue
- Nausea
- Poor appetite
Medical History
The fever was sudden in onset and associated with chills and severe myalgia. The patient reported living in an area with recent mosquito activity.
On day 4 of illness, he developed mild gum bleeding while brushing his teeth. There was no previous history of dengue.
There was no history of cough, burning micturition, abdominal pain or diarrhoea.
Clinical Presentation
The patient presented with an acute febrile illness characterised by high-grade fever, severe headache, retro-orbital pain and generalised body ache. He also reported marked fatigue, nausea and poor appetite.
On day 4 of illness, he noticed mild gum bleeding while brushing his teeth. There was no significant bleeding otherwise.
The patient’s history of living in an area with recent mosquito activity, combined with his clinical symptoms, raised suspicion of dengue infection.
Clinical Examination
On examination, the following findings were noted:
- Temperature: 39.2°C
- Pulse: 96/min
- Blood Pressure: 112/74 mmHg
- SpO₂: 98% on room air
- General condition: Conscious and oriented
- Mild facial flushing
- No significant lymphadenopathy
- Mild right upper-quadrant discomfort without organomegaly
- No significant bleeding on examination
At presentation, there was no evidence of shock or severe organ involvement. The patient was haemodynamically stable and able to maintain oral fluid intake.
Diagnostic Assessment
Laboratory investigations revealed:
Investigation | Result |
Haemoglobin | 14.2 g/dL |
Total leukocyte count | 3,200/µL |
Platelet count | 118,000/µL |
Haematocrit | 44% |
AST | 86 U/L |
ALT | 62 U/L |
Creatinine | 0.9 mg/dL |
CRP | Mildly elevated |
Dengue NS1 antigen | Positive |
The clinical presentation and positive NS1 antigen supported the diagnosis of acute dengue infection.
Diagnosis
- Dengue fever – Febrile phase
- Dengue without evidence of shock or severe organ involvement at presentation
Therapeutic Intervention
A structured treatment and monitoring plan was initiated to maintain adequate hydration, control symptoms, and identify any early signs of deterioration.
Fluid Management
Adequate oral fluid intake was encouraged because the patient was haemodynamically stable and able to drink.
If oral intake became inadequate or signs of plasma leakage developed, intravenous isotonic crystalloid therapy would be considered with careful reassessment.
The principle was to provide enough fluid to maintain adequate perfusion while avoiding fluid overload.
Symptomatic Treatment
Paracetamol was used for fever and pain.
The patient was advised to avoid aspirin and NSAIDs because of the risk of bleeding. Adequate rest and hydration were also advised.
Clinical Monitoring
The patient was monitored for:
- Blood pressure and pulse pressure
- Heart rate
- Capillary refill
- Urine output
- Mental status
- Haematocrit trend
- Platelet trend
- Evidence of bleeding
- Abdominal pain
- Persistent vomiting
- Hepatomegaly
- Fluid accumulation
- Respiratory distress
Clinical Deterioration Scenario
On day 5, the patient’s fever subsided, but he developed increasing abdominal pain, persistent vomiting, restlessness and reduced urine output.
His laboratory results showed a rising haematocrit.
The rising haematocrit with clinical deterioration raised concern for plasma leakage and evolving dengue shock.
This patient would require urgent reassessment and appropriate fluid resuscitation with close haemodynamic monitoring.
Warning Signs of Dengue
Important warning signs include:
- Severe abdominal pain or tenderness
- Persistent vomiting
- Clinical fluid accumulation
- Mucosal bleeding
- Lethargy or restlessness
- Liver enlargement
- Progressive rise in haematocrit with rapid fall in platelet count
Patients with warning signs require closer observation and management.
Severe Dengue
Severe dengue is characterised by one or more of the following:
- Severe plasma leakage leading to shock or respiratory distress
- Severe bleeding
- Severe organ involvement such as significant hepatic, neurological or cardiac involvement
A falling platelet count alone does not indicate severe dengue. The patient’s overall clinical condition, haematocrit trend, evidence of plasma leakage, bleeding and organ involvement must be considered.
Follow-Up and Outcomes
After appropriate fluid management and close monitoring, the patient’s haemodynamic status stabilised.
Urine output improved, haematocrit gradually decreased, and platelet count subsequently recovered.
The patient was discharged after clinical recovery with advice regarding:
- Adequate hydration
- Warning symptoms
- Follow-up
- Mosquito-bite prevention
Discussion
Dengue progresses through febrile, critical and recovery phases, with the period around defervescence requiring particular vigilance. In this case, the initial presentation was consistent with dengue fever in the febrile phase, without evidence of shock or severe organ involvement.
The development of increasing abdominal pain, persistent vomiting, restlessness and reduced urine output on day 5, together with a rising haematocrit, raised concern for plasma leakage and evolving dengue shock. This highlights the importance of monitoring the patient’s clinical condition rather than relying on platelet count alone.
Careful fluid management, appropriate symptomatic treatment, close haemodynamic monitoring and early recognition of warning signs are essential. Aspirin and NSAIDs should be avoided because of the risk of bleeding.
Conclusion
This case highlights the importance of recognising dengue warning signs and monitoring patients closely around defervescence. Rising haematocrit with clinical deterioration can indicate plasma leakage and requires prompt reassessment and appropriate fluid management.
Early recognition and timely management can help prevent progression to severe dengue. Continued follow-up, adequate hydration and mosquito-bite prevention are also important following recovery.
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Note: This case study is for illustrative and educational purposes only and should not replace professional medical advice. If you have concerns about your health or symptoms suggestive of dengue, please consult with a qualified healthcare provider.
