Dengue Fever Management Calculator
Based on WHO and National Guidelines for Prevention, Management and Control of Dengue
Patient Assessment
Assessment Result
About Dengue Fever
Dengue infection is a systemic and dynamic disease with a wide clinical spectrum that includes both severe and non-severe clinical manifestations. The key to management is early recognition and understanding of the clinical problems during the different phases of the disease.
Key Facts:
- Dengue is caused by a virus of the Flaviviridae family with four serotypes (DENV-1, DENV-2, DENV-3, DENV-4)
- Transmitted by Aedes mosquitoes (Aedes aegypti and Aedes albopictus)
- Estimated 390 million dengue infections occur annually worldwide
- Early notification is crucial for identifying outbreaks and initiating response
Dengue Classification and Management Groups
WHO Dengue Case Classification
The WHO classifies dengue into three main categories:
- Dengue without warning signs – Fever with two or more of: nausea/vomiting, rash, aches and pains, positive tourniquet test, leukopenia
- Dengue with warning signs – Dengue fever with abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, or increasing HCT with rapid platelet decrease
- Severe dengue – Dengue with severe plasma leakage, severe bleeding, or severe organ impairment
Management Groups
| Group | Classification | Management Setting | Key Features |
|---|---|---|---|
| Group A | Dengue without warning signs | May be sent home |
|
| Group B | Dengue with warning signs OR with specific risk factors | Referred for in-hospital care |
|
| Group C | Severe dengue | Require emergency treatment |
|
Clinical Phases of Dengue
1. Febrile Phase (Days 1-7)
Sudden high-grade fever, headache, retro-orbital pain, myalgia, arthralgia, rash, positive tourniquet test.
2. Critical Phase (Around defervescence)
Plasma leakage that may lead to shock, hemorrhagic manifestations, organ impairment. Usually lasts 24-48 hours.
3. Recovery Phase (Days 7-10)
Gradual reabsorption of extravascular fluid, hemodynamic stabilization, improving appetite, and convalescent rash.
| Phase | Key Features | Management Focus |
|---|---|---|
| Febrile | High fever, body aches, rash | Symptomatic treatment, hydration, monitoring |
| Critical | Plasma leakage, rising HCT, falling platelets | Judicious fluid therapy, shock management |
| Recovery | Reabsorption, diuresis, convalescent rash | Monitor for fluid overload, electrolyte balance |
Monitoring Parameters
Clinical Monitoring:
- Vital signs (temperature, pulse, BP, respiratory rate)
- Mental status and level of consciousness
- Peripheral perfusion (capillary refill time, skin temperature)
- Urine output (goal: ≥0.5 mL/kg/hr)
- Signs of bleeding
- Abdominal tenderness, hepatomegaly
- Respiratory distress
Laboratory Monitoring:
- Hematocrit (serial measurements to track plasma leakage)
- Platelet count
- White blood cell count
- Liver function tests (AST, ALT)
- Renal function tests
- Coagulation profile (if bleeding manifestations)
- Blood glucose
Group-Specific Monitoring
Group A (Home Management):
- Daily review for disease progression
- Watch for decreasing WBC, platelet count, and increasing hematocrit
- Monitor for warning signs, especially around defervescence
Group B (Hospital Management):
- Vital signs and peripheral perfusion (1-4 hourly until out of critical phase)
- Urine output (4-6 hourly)
- Hematocrit (before and after fluid replacement, then 6-12 hourly)
- Blood glucose
- Other organ functions as indicated
Group C (Emergency Management):
- Continuous monitoring of vital signs
- Serial hematocrit measurements (every 2-4 hours initially)
- Urine output (hourly, consider catheterization)
- Organ function tests (frequent monitoring)
- Coagulation profile
- Blood gas analysis if indicated
Important: Hematocrit should be measured before and after fluid resuscitation and repeated every 6-12 hours during the critical phase.