Severe Dengue Infection


Sukhveer (Sukhi) Bains, MD, MA Assistant Professor of Clinical Emergency Medicine and Clinical Internal Medicine, University of Illinois at Chicago



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

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