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Dengue

Last edited: 4/14/2026

Overview

Dengue is a mosquito-borne viral infection caused by any of four dengue virus serotypes (DENV-1 to DENV-4), leading to a spectrum of illness from mild febrile disease to severe dengue with hemorrhagic manifestations and shock 135.

Diagnosis

  • Clinical Criteria: High fever, headache, retro-orbital pain, joint and muscle pain, rash, and bleeding manifestations 1411.
  • Laboratory Tests:
    • - Serological tests (IgM and IgG antibodies) 40. - NS1 antigen detection for early diagnosis 12. - RT-PCR for viral RNA detection 12.
  • Grading:
    • - WHO classification: Dengue without warning signs, Dengue with warning signs, Severe dengue 118. - Modified SOFA score for severe dengue assessment 18.

    Management

  • Supportive Care:
    • - Fluid resuscitation for dehydration 118. - Blood transfusion for severe hemorrhage 118. - Inotropic support for shock 118.
  • Monitoring:
    • - Close monitoring of vital signs, fluid balance, and organ function 11826.
  • Antiviral Therapy:
    • - No specific antiviral treatment recommended; management is primarily supportive 15.
  • Corticosteroids:
    • - Use controversial; may be considered in corticosteroid-responsive prolonged thrombocytopenia 2242.

    Special Populations

  • Pediatrics:
    • - Higher risk of severe dengue, including dengue shock syndrome 2934. - Unique presentations like multiorgan dysfunction 21.
  • Comorbidities:
    • - Sickle cell disease increases risk of severe dengue 22. - Patients with dengue may develop unusual complications like dengue hepatitis and acute pancreatitis 1424.

    Key Recommendations

  • Implement Early and Aggressive Fluid Management for suspected dengue patients with signs of shock or dehydration (Evidence: Strong 118).
  • Utilize NS1 Antigen Testing for rapid diagnosis in the early phase of dengue infection (Evidence: Moderate 12).
  • Monitor for and Manage Organ Dysfunction using biomarkers like procalcitonin and lactate to predict severe outcomes (Evidence: Moderate 28).
  • Consider Corticosteroids in cases of prolonged thrombocytopenia unresponsive to other treatments (Evidence: Weak 2242).
  • Enhance Surveillance and Reporting Systems for vaccine safety, particularly for rare adverse events like anaphylaxis (Evidence: Moderate 10).

    • References

    1 Zhu T, Xiao X, Zhu X, Wang X. Hospitalised Dengue Patients and Risk of Hypertension: A Systematic Review and Meta-Analysis. Reviews in medical virology 2025. link 2 Bykowska-Tumasz M, Sikorska KT. Controversy about recommendation of vaccination against dengue fever in seafarers. International maritime health 2025. link 3 Hassan A, Mahmood MS, Idrees M, Afzal S. Development of a Multiple Epitopes-Based Dengue Vaccine: An Immunoinformatics Approach and Insights From Pakistani Population Genetics. Microbiology and immunology 2025. link 4 Lim JT, Wee LE, Tan WZ, Chiew C, Kurupatham L, Poh C et al.. Characterization of post-acute multi-organ sequelae following dengue infection. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2025. link 5 Van Truong L, Thuy LT, Hien LT, Tran TQM, Gad A, Tran L et al.. From controversy to confidence: Strengthening dengue vaccines safety reporting. Vaccine 2025. link 6 Triunfol M. Brazil is hoping and waiting for a new vaccine as dengue rages. Science (New York, N.Y.) 2024. link 7 Akther F, Martinez DR. Pre-vax metabolic clues: Cracking the code to a better dengue vaccine. Science immunology 2024. link 8 Hameed M, Khan ST, Kulsoom S. Unravelling the Diagnostic Potential of MR Imaging in Dengue Encephalitis: A Call for Further Exploration in Pakistan. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2024. link 9 Alsaiari AA, Hakami MA, Alotaibi BS, Alkhalil SS, Hazazi A, Alkhorayef N et al.. Rational design of multi-epitope-based vaccine by exploring all dengue virus serotypes proteome: an immunoinformatic approach. Immunologic research 2024. link 10 Percio J, Kobayashi CD, Silva RMA, Marinho AKBB, Capovilla L, Andrade PHS et al.. Safety signal detected: Anaphylaxis after attenuated dengue vaccine (TAK-003) - Brazil, march 1, 2023-march 11, 2024. Vaccine 2024. link 11 Jones AM, Saretsky TL, Panter C, Wells JR, White F, Smith V et al.. Measuring dengue illness intensity: Development and content validity of the dengue virus daily diary (DENV-DD). Journal of patient-reported outcomes 2023. link 12 Sunari IGAAEP, Aryati A, Hakim FKN, Tanzilia MF, Zuroidah N, Wrahatnala BJ et al.. Non-structural protein 1 and hematology parameters as predictors of dengue virus infection severity in Indonesia. Journal of medicine and life 2023. link 13 Aryal E, Bista R, Shrestha PR, Regmi G. Dengue Fever among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA; journal of the Nepal Medical Association 2023. link 14 Prajapati R, Mehta R, Kabrawala M, Nandwani S, Patel N, Sethia M et al.. Dengue hepatitis: Incidence, spectrum and outcome. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2023. link 15 Harrison RE, Yang X, Eum JH, Martinson VG, Dou X, Valzania L et al.. The mosquito Aedes aegypti requires a gut microbiota for normal fecundity, longevity and vector competence. Communications biology 2023. link 16 Leslie M. Dengue and zika viruses turn people into mosquito bait. Science (New York, N.Y.) 2022. link 17 Chhabra G, Das B, Mishra S, Mishra B. Rapid screening of dengue fever using research parameters from new generation hematological analyzers. International journal of laboratory hematology 2022. link 18 McBride A, Vuong NL, Van Hao N, Huy NQ, Chanh HQ, Chau NTX et al.. A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials. BMC infectious diseases 2022. link 19 Laoprasopwattana K, Khantee P, Saelim K, Geater A. Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue. The Pediatric infectious disease journal 2022. link 20 Malik MW, Ikram A, Safdar RM, Ansari JA, Khan MA, Rathore TR et al.. Use of public health emergency operations center (PH-EOC) and adaptation of incident management system (IMS) for efficient inter-sectoral coordination and collaboration for effective control of Dengue fever outbreak in Pakistan - 2019. Acta tropica 2021. link 21 Kazi MA, Ghosh S, Roychowdhury S, Giri PP, Sarkar M. A Case Study of Dual Infection of Dengue and COVID-19: Presenting as Multiorgan Dysfunction in an Infant. Journal of tropical pediatrics 2021. link 22 Elenga N, Celicourt D, Muanza B, Elana G, Hocquelet S, Tarer V et al.. Dengue in hospitalized children with sickle cell disease: A retrospective cohort study in the French departments of America. Journal of infection and public health 2020. link 23 Musso D, Nhan TX, de Pina JJ, Marchi J, Texier G. The Use of Simple Laboratory Parameters in the Differential Diagnosis of Acute-Phase Zika and Dengue Viruses. Intervirology 2019. link 24 Nawal CL, Meena PD, Chejara RS, Jain S, Marker S, Tuteja V. Dengue Fever as a Rare Cause of Acute Pancreatitis. The Journal of the Association of Physicians of India 2018. link 25 Ghosh S, Singh R, Ghosh S, Chawla A. Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome. BMJ case reports 2018. link 26 Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH. Determinants of mortality and prolonged hospital stay among dengue patients attending tertiary care hospital: a cross-sectional retrospective analysis. BMJ open 2017. link 27 Cavalcanti LP, Braga DN, da Silva LM, Aguiar MG, Castiglioni M, Silva-Junior JU et al.. Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool. The American journal of tropical medicine and hygiene 2016. link 28 Thanachartwet V, Desakorn V, Sahassananda D, Jittmittraphap A, Oer-Areemitr N, Osothsomboon S et al.. Serum Procalcitonin and Peripheral Venous Lactate for Predicting Dengue Shock and/or Organ Failure: A Prospective Observational Study. PLoS neglected tropical diseases 2016. link 29 Aurpibul L, Khumlue P, Issaranggoon na ayuthaya S, Oberdorfer P. Dengue shock syndrome in an infant. BMJ case reports 2014. link 30 Vera-Polania F, Perilla-Gonzalez Y, Martinez-Pulgarin DF, Baquero-Rodriguez JD, Munoz-Urbano M, Lagos-Gallego M et al.. Bibliometric assessment of the Latin-American contributions in dengue. Recent patents on anti-infective drug discovery 2014. link 31 Lee YR, Hu HY, Kuo SH, Lei HY, Lin YS, Yeh TM et al.. Dengue virus infection induces autophagy: an in vivo study. Journal of biomedical science 2013. link 32 Hapuarachchi HC, Oh HM, Thein TL, Pok KY, Lai YL, Tan LK et al.. Clinico-genetic characterisation of an encephalitic Dengue virus 4 associated with multi-organ involvement. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 2013. link 33 La-Orkhun V, Supachokchaiwattana P, Lertsapcharoen P, Khongphatthanayothin A. Spectrum of cardiac rhythm abnormalities and heart rate variability during the convalescent stage of dengue virus infection: a Holter study. Annals of tropical paediatrics 2011. link 34 Juneja D, Nasa P, Singh O, Javeri Y, Uniyal B, Dang R. Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue. Journal of critical care 2011. link 35 Larbcharoensub N, Aroonroch R, Kanoksil W, Leopairut J, Nitiyanant P, Khositseth A et al.. Infection-associated hemophagocytic syndrome among patients with dengue shock syndrome and invasive aspergillosis: a case series and review of the literature. The Southeast Asian journal of tropical medicine and public health 2011. link 36 Falconar AK, Martinez F. The NS1 glycoprotein can generate dramatic antibody-enhanced dengue viral replication in normal out-bred mice resulting in lethal multi-organ disease. PloS one 2011. link 37 Schmitz L, Prayag S, Varghese S, Jog S, Bhargav-Patil P, Yadav A et al.. Nonhematological organ dysfunction and positive fluid balance are important determinants of outcome in adults with severe dengue infection: a multicenter study from India. Journal of critical care 2011. link 38 Wijekoon CN, Wijekoon PW. Dengue hemorrhagic fever presenting with acute pancreatitis. The Southeast Asian journal of tropical medicine and public health 2010. link 39 Heymann WR. Dengue fever. Journal of the American Academy of Dermatology 2009. link 40 Wu SJ, Paxton H, Hanson B, Kung CG, Chen TB, Rossi C et al.. Comparison of two rapid diagnostic assays for detection of immunoglobulin M antibodies to dengue virus. Clinical and diagnostic laboratory immunology 2000. link 41 Cherian T, Ponnuraj E, Kuruvilla T, Kirubakaran C, John TJ, Raghupathy P. An epidemic of dengue haemorrhagic fever & dengue shock syndrome in & around Vellore. The Indian journal of medical research 1994. link 42 Leong KW, Srinivas P. Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever. The Medical journal of Malaysia 1993. link 43 Nagarkatti M, Nagarkatti PS. Suppression of intrinsic B-cell function in Dengue-infected mice. Experientia 1979. link

    Original source

    1. [1]
      Hospitalised Dengue Patients and Risk of Hypertension: A Systematic Review and Meta-Analysis. — Zhu T, Xiao X, Zhu X, Wang X Reviews in medical virology (2025)
    2. [2]
      Controversy about recommendation of vaccination against dengue fever in seafarers. — Bykowska-Tumasz M, Sikorska KT International maritime health (2025)
    3. [3]
      Development of a Multiple Epitopes-Based Dengue Vaccine: An Immunoinformatics Approach and Insights From Pakistani Population Genetics. — Hassan A, Mahmood MS, Idrees M, Afzal S Microbiology and immunology (2025)
    4. [4]
      Characterization of post-acute multi-organ sequelae following dengue infection. — Lim JT, Wee LE, Tan WZ, Chiew C, Kurupatham L, Poh C et al. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (2025)
    5. [5]
      From controversy to confidence: Strengthening dengue vaccines safety reporting. — Van Truong L, Thuy LT, Hien LT, Tran TQM, Gad A, Tran L et al. Vaccine (2025)
    6. [6]
      Brazil is hoping and waiting for a new vaccine as dengue rages. — Triunfol M Science (New York, N.Y.) (2024)
    7. [7]
      Pre-vax metabolic clues: Cracking the code to a better dengue vaccine. — Akther F, Martinez DR Science immunology (2024)
    8. [8]
      Unravelling the Diagnostic Potential of MR Imaging in Dengue Encephalitis: A Call for Further Exploration in Pakistan. — Hameed M, Khan ST, Kulsoom S Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (2024)
    9. [9]
      Rational design of multi-epitope-based vaccine by exploring all dengue virus serotypes proteome: an immunoinformatic approach. — Alsaiari AA, Hakami MA, Alotaibi BS, Alkhalil SS, Hazazi A, Alkhorayef N et al. Immunologic research (2024)
    10. [10]
      Safety signal detected: Anaphylaxis after attenuated dengue vaccine (TAK-003) - Brazil, march 1, 2023-march 11, 2024. — Percio J, Kobayashi CD, Silva RMA, Marinho AKBB, Capovilla L, Andrade PHS et al. Vaccine (2024)
    11. [11]
      Measuring dengue illness intensity: Development and content validity of the dengue virus daily diary (DENV-DD). — Jones AM, Saretsky TL, Panter C, Wells JR, White F, Smith V et al. Journal of patient-reported outcomes (2023)
    12. [12]
      Non-structural protein 1 and hematology parameters as predictors of dengue virus infection severity in Indonesia. — Sunari IGAAEP, Aryati A, Hakim FKN, Tanzilia MF, Zuroidah N, Wrahatnala BJ et al. Journal of medicine and life (2023)
    13. [13]
      Dengue Fever among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study. — Aryal E, Bista R, Shrestha PR, Regmi G JNMA; journal of the Nepal Medical Association (2023)
    14. [14]
      Dengue hepatitis: Incidence, spectrum and outcome. — Prajapati R, Mehta R, Kabrawala M, Nandwani S, Patel N, Sethia M et al. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (2023)
    15. [15]
      The mosquito Aedes aegypti requires a gut microbiota for normal fecundity, longevity and vector competence. — Harrison RE, Yang X, Eum JH, Martinson VG, Dou X, Valzania L et al. Communications biology (2023)
    16. [16]
      Dengue and zika viruses turn people into mosquito bait. — Leslie M Science (New York, N.Y.) (2022)
    17. [17]
      Rapid screening of dengue fever using research parameters from new generation hematological analyzers. — Chhabra G, Das B, Mishra S, Mishra B International journal of laboratory hematology (2022)
    18. [18]
      A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials. — McBride A, Vuong NL, Van Hao N, Huy NQ, Chanh HQ, Chau NTX et al. BMC infectious diseases (2022)
    19. [19]
      Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue. — Laoprasopwattana K, Khantee P, Saelim K, Geater A The Pediatric infectious disease journal (2022)
    20. [20]
      Use of public health emergency operations center (PH-EOC) and adaptation of incident management system (IMS) for efficient inter-sectoral coordination and collaboration for effective control of Dengue fever outbreak in Pakistan - 2019. — Malik MW, Ikram A, Safdar RM, Ansari JA, Khan MA, Rathore TR et al. Acta tropica (2021)
    21. [21]
      A Case Study of Dual Infection of Dengue and COVID-19: Presenting as Multiorgan Dysfunction in an Infant. — Kazi MA, Ghosh S, Roychowdhury S, Giri PP, Sarkar M Journal of tropical pediatrics (2021)
    22. [22]
      Dengue in hospitalized children with sickle cell disease: A retrospective cohort study in the French departments of America. — Elenga N, Celicourt D, Muanza B, Elana G, Hocquelet S, Tarer V et al. Journal of infection and public health (2020)
    23. [23]
      The Use of Simple Laboratory Parameters in the Differential Diagnosis of Acute-Phase Zika and Dengue Viruses. — Musso D, Nhan TX, de Pina JJ, Marchi J, Texier G Intervirology (2019)
    24. [24]
      Dengue Fever as a Rare Cause of Acute Pancreatitis. — Nawal CL, Meena PD, Chejara RS, Jain S, Marker S, Tuteja V The Journal of the Association of Physicians of India (2018)
    25. [25]
      Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome. — Ghosh S, Singh R, Ghosh S, Chawla A BMJ case reports (2018)
    26. [26]
      Determinants of mortality and prolonged hospital stay among dengue patients attending tertiary care hospital: a cross-sectional retrospective analysis. — Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH BMJ open (2017)
    27. [27]
      Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool. — Cavalcanti LP, Braga DN, da Silva LM, Aguiar MG, Castiglioni M, Silva-Junior JU et al. The American journal of tropical medicine and hygiene (2016)
    28. [28]
      Serum Procalcitonin and Peripheral Venous Lactate for Predicting Dengue Shock and/or Organ Failure: A Prospective Observational Study. — Thanachartwet V, Desakorn V, Sahassananda D, Jittmittraphap A, Oer-Areemitr N, Osothsomboon S et al. PLoS neglected tropical diseases (2016)
    29. [29]
      Dengue shock syndrome in an infant. — Aurpibul L, Khumlue P, Issaranggoon na ayuthaya S, Oberdorfer P BMJ case reports (2014)
    30. [30]
      Bibliometric assessment of the Latin-American contributions in dengue. — Vera-Polania F, Perilla-Gonzalez Y, Martinez-Pulgarin DF, Baquero-Rodriguez JD, Munoz-Urbano M, Lagos-Gallego M et al. Recent patents on anti-infective drug discovery (2014)
    31. [31]
      Dengue virus infection induces autophagy: an in vivo study. — Lee YR, Hu HY, Kuo SH, Lei HY, Lin YS, Yeh TM et al. Journal of biomedical science (2013)
    32. [32]
      Clinico-genetic characterisation of an encephalitic Dengue virus 4 associated with multi-organ involvement. — Hapuarachchi HC, Oh HM, Thein TL, Pok KY, Lai YL, Tan LK et al. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology (2013)
    33. [33]
      Spectrum of cardiac rhythm abnormalities and heart rate variability during the convalescent stage of dengue virus infection: a Holter study. — La-Orkhun V, Supachokchaiwattana P, Lertsapcharoen P, Khongphatthanayothin A Annals of tropical paediatrics (2011)
    34. [34]
      Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue. — Juneja D, Nasa P, Singh O, Javeri Y, Uniyal B, Dang R Journal of critical care (2011)
    35. [35]
      Infection-associated hemophagocytic syndrome among patients with dengue shock syndrome and invasive aspergillosis: a case series and review of the literature. — Larbcharoensub N, Aroonroch R, Kanoksil W, Leopairut J, Nitiyanant P, Khositseth A et al. The Southeast Asian journal of tropical medicine and public health (2011)
    36. [36]
      The NS1 glycoprotein can generate dramatic antibody-enhanced dengue viral replication in normal out-bred mice resulting in lethal multi-organ disease. — Falconar AK, Martinez F PloS one (2011)
    37. [37]
      Nonhematological organ dysfunction and positive fluid balance are important determinants of outcome in adults with severe dengue infection: a multicenter study from India. — Schmitz L, Prayag S, Varghese S, Jog S, Bhargav-Patil P, Yadav A et al. Journal of critical care (2011)
    38. [38]
      Dengue hemorrhagic fever presenting with acute pancreatitis. — Wijekoon CN, Wijekoon PW The Southeast Asian journal of tropical medicine and public health (2010)
    39. [39]
      Dengue fever. — Heymann WR Journal of the American Academy of Dermatology (2009)
    40. [40]
      Comparison of two rapid diagnostic assays for detection of immunoglobulin M antibodies to dengue virus. — Wu SJ, Paxton H, Hanson B, Kung CG, Chen TB, Rossi C et al. Clinical and diagnostic laboratory immunology (2000)
    41. [41]
      An epidemic of dengue haemorrhagic fever & dengue shock syndrome in & around Vellore. — Cherian T, Ponnuraj E, Kuruvilla T, Kirubakaran C, John TJ, Raghupathy P The Indian journal of medical research (1994)
    42. [42]
      Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever. — Leong KW, Srinivas P The Medical journal of Malaysia (1993)
    43. [43]
      Suppression of intrinsic B-cell function in Dengue-infected mice. — Nagarkatti M, Nagarkatti PS Experientia (1979)
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