Sukhveer (Sukhi) Bains, MD, MA Assistant Professor of Clinical Emergency Medicine and Clinical Internal Medicine, University of Illinois at Chicago
Diagnosis
Dengue virus infection is largely a clinical diagnosis. The WHO-TDR has developed a simplified and binary system of classification for dengue infection. They classify infection as either (1) dengue infection with or without warning signs or (2) severe dengue infection. [2, 14] Clinicians should suspect dengue infection in patients with possible exposure (travel or endemic) and fever and two of the following characteristics: [2, 14]
- Nausea/vomiting
- Rash
- Aches and pains
- Positive tourniquet test result
- Leukopenia
- Any warning sign
Warning signs for dengue include the following: [2, 14]
- Abdominal pain or tenderness
- Persistent vomiting
- Clinical fluid accumulation
- Mucosal bleeding
- Lethargy, restlessness
- Liver enlargement of more than 2 cm
- Laboratory: Increased hematocrit coupled with rapid decrease in platelet count
Severe dengue infection diagnosis criteria include the following: [2, 14]
- Severe plasma leakage leading to shock and/or fluid accumulation with respiratory distress
- Severe hemorrhage
- Severe organ impairment
RNA PCR testing is available for DENV1-4 through the CDC for diagnosis during the first 5 days of infection (after this period, IgM ELISA testing is preferred), although this is unlikely to assist directly in emergency department management. [2]Information on how to obtain PCR testing in suspected cases can be found at https://www.cdc.gov/dengue/resources/TestpolEng_2.pdf.