Public - Dengue - Diagnosis

Dengue

Author: Suranjith L. Seneviratne, MD, DPhil, MRCP, FRCPath; Panduka Karunanayake, MD, MRCP; Bandula Wijesiriwardena, MD, FRCP, FCCP, FCMSA, FRACP, FACP
Editorial changes - 2009-11-13
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

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Diagnosis
Use history to help distinguish dengue from other febrile infectious diseases. Look for physical exam findings that suggest a diagnosis of dengue. Use laboratory testing to confirm the diagnosis of dengue. Consider the broad range of febrile diseases common in the tropics in the differential diagnosis of dengue.
History and Physical Examination Elements for Dengue (table)
Laboratory and Other Studies for Dengue (table)
Differential Diagnosis of the Dengue Presentation (table)


Use history to help distinguish dengue from other febrile infectious diseases.
Ask about: Duration of symptoms Fever Chills Sweats Nausea Vomiting Rash Lassitude Headache Retro-orbital pain Myalgia Arthralgia Body aches Hemorrhagic manifestations involving the skin, nose, mouth, or gastrointestinal tract Recent travel history Ask about symptoms that may be characteristic of but not necessarily specific for dengue: Fever Myalgia Retro-orbital pain Ask about symptoms that are usually not characteristic of dengue: Productive cough Profuse, watery diarrhea Allergic phenomena Obtain a detailed travel history, including: Travel to areas where dengue is epidemic or where recent epidemics have occurred Duration of visit Type of lodging Type of travel Type of food and water ingested Onset of symptoms in relation to leaving a dengue-endemic area (if more than 2 weeks has passed, then dengue is effectively ruled out) Potential mosquito exposure and occurrence of insect bites Mosquitoes seen in home, work, or recreation environments Standing water around the home or workplace Use of barrier methods (e.g., screens, long-sleeved shirts) and protective measures (e.g., DEET) Illness in travel companions, which may indicate group exposure to pathogenic agents, such as enteric bacteria or schistosomes Chemoprophylaxis regimes and stand-by antibiotics Sexual activity Ask about pretravel vaccinations: Yellow fever Salmonella typhi Influenza See table History and Physical Examination Elements for Dengue. See table WHO Case Definitions for Dengue Fever, Dengue Hemorrhagic Fever, and Dengue Shock Syndrome.
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Look for physical exam findings that suggest a diagnosis of dengue.
Look for: Fever Hemorrhagic manifestations, such as petechiae, purpura, ecchymoses, nose bleeds, or a positive tourniquet test result Skin rash Signs of circulatory compromise, such as cold, clammy extremities; rapid pulse; low blood pressure; or reduced pulse pressure Abdominal tenderness, particularly in the right upper quadrant Neurologic abnormalities, such as altered levels of consciousness, confusion, or coma See table History and Physical Examination Elements for Dengue. See table WHO Case Definitions for Dengue Fever, Dengue Hemorrhagic Fever, and Dengue Shock Syndrome. See table Disease Severity of Dengue Hemorrhagic Fever.
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Use laboratory testing to confirm the diagnosis of dengue.
Select the most appropriate test for confirming dengue, depending on the stage of the illness, including culture of the virus, PCR tests, or serologic assays. Know the benefits and limitations of rapid diagnostic tests for dengue. See table Laboratory and Other Studies for Dengue. See table Tests for Diagnosing Dengue Viral Infections. See table Interpretation of Dengue Test Results.
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Consider the broad range of febrile diseases common in the tropics in the differential diagnosis of dengue.
Focus on the elements of the history and physical exam that help to differentiate dengue from other febrile illnesses. Consider the following in the differential diagnosis of dengue: Viral diseases Chikungunya virus Yellow fever Hantavirus Measles Rubella Enteroviruses Influenza Hepatitis A, B Bacterial diseases Meningococcemia Scarlet fever Typhoid Leptospirosis Rickettsial diseases Parasitic diseases Malaria Schistosomiasis See table Differential Diagnosis of the Dengue Presentation.
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FAQs

Bandula Wijesiriwardena, MD, FRCP, FCCP, FCMSA, FRACP, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Panduka Karunanayake, MD, MRCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Suranjith L. Seneviratne, MD, DPhil, MRCP, FRCPath has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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