Dengue Fever: Symptoms, Warning Signs, Platelets and Recovery

Every monsoon and post monsoon season, dengue sends thousands of Indians to hospital. Most people recover fully with rest and fluids at home, but knowing the warning signs can be lifesaving.

How dengue spreads

Dengue is caused by a virus carried by Aedes mosquitoes. Unlike malaria mosquitoes, they bite mainly during the day, especially early morning and late afternoon, and breed in small collections of clean, still water: coolers, flower pots, buckets, tyres and rooftop tanks.

There are four types of dengue virus. Infection with one gives lifelong immunity to that type only; a second infection with a different type carries a higher risk of severe dengue.

Symptoms

Symptoms usually start 4 to 10 days after the bite:

• sudden high fever (often 40°C / 104°F)
• severe headache and pain behind the eyes
• intense muscle and joint pain, hence the old name "breakbone fever"
• nausea and vomiting
• a red rash, often appearing a few days in
• tiredness that can last weeks

Warning signs: get to hospital

The most dangerous period is often when the fever starts to drop, usually between days 3 and 7. Go to a hospital immediately if you or someone you're caring for has:

• severe abdominal pain or tenderness
• vomiting at least three times in 24 hours, or unable to keep fluids down
• bleeding from the gums or nose, blood in vomit or stool, or black stools
• unusual drowsiness, restlessness or irritability
• cold, clammy skin or fainting
• passing very little urine
• difficulty breathing

Diagnosis and platelet counts

Doctors confirm dengue with an NS1 antigen test in the first few days or IgM antibody tests after about day 5. A complete blood count (CBC) tracks the platelet count and haematocrit.

A falling platelet count is common and alarming to families, but platelet count alone rarely decides treatment. Doctors watch for warning signs, a rising haematocrit (blood thickening due to fluid leak) and bleeding. Platelet transfusions are only needed in specific situations, such as active bleeding or very low counts with other risks.

Treatment at home

There is no specific antiviral medicine for dengue. Care focuses on fluids and monitoring:

1. Drink plenty of fluids: water, ORS, coconut water, soups, buttermilk and fresh juices. Aim to pass urine at least every 4 to 6 hours.
2. Rest.
3. Use paracetamol for fever and pain, at the dose advised by your doctor (in adults, usually no more than 4 g a day).
4. Avoid ibuprofen, aspirin, diclofenac and other NSAIDs, which increase bleeding risk.
5. Get follow up blood tests as advised, even if you feel better.

Papaya leaf extract is widely used in India. Some small studies suggest it may raise platelet counts, but it hasn't been shown to prevent severe dengue: it must never replace fluids, monitoring or hospital care.

Recovery

Fever typically settles within a week, but fatigue, weakness and low mood can linger for several weeks. Ease back into work and exercise gradually.

Prevention

• Empty, scrub and cover water containers every week; change cooler water often.
• Use window screens and bed nets, even for daytime naps.
• Wear long sleeves and use mosquito repellent on exposed skin.
• Support community fogging and source reduction drives.

A dengue vaccine is approved in some countries for people who've had a previous infection, and Indian vaccine candidates are in trials. Ask your doctor about current availability.