Fever in the tropics

A 25-year-old man from Kerala reports to the local clinic in late September with symptoms of fever, retro-orbital headache, muscle pains, persistent vomiting and lethargy. He has a positive tourniquet test and full blood count reveals thrombocytopenia.

Given the likely diagnosis, what is the most appropriate initial management?

• 0%A) Start intravenous rehydration and monitor hematocrit
• 0%B) Prescribe a course of antibiotics
• 0%C) Administer anti-malarial medication
• 0%D) Begin treatment with antiviral drugs

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Dengue fever is a mosquito-borne flavivirus infection prevalent in tropical and subtropical regions around the world primarily transmitted through the salivary glands of the infected female Aedes aegypti mosquito.

Four serotypes exist: DENV-1, DENV-2, DENV-3 and DENV-4. Characteristic features of dengue include high fever, retro-orbital pain, headache, myalgia, joint pains and a maculopapular rash.

While most cases are mild and self-limiting, severe forms like dengue hemorrhagic fever and dengue shock syndrome can be life-threatening, requiring careful clinical management to prevent complications.

The WHO classifies dengue into three categories: probable dengue, dengue with warning signs and severe dengue.

Warning signs include (not exhaustively); abdominal pain, persistent vomiting, mucosal bleeding, raised haematocrit and lethargy. Severe dengue includes patients with plasma leakage (leading to shock and / or fluid accumulation e.g. pleural effusions) and those with severe bleeding or end organ failure.

Intravenous rehydration is needed in severe cases or if the patient is unable to maintain oral intake.

Antibiotics are not effective as dengue is a viral infection, and antiviral drugs are not typically used in its treatment.