Dengue fever physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The physical examination in Dengue fever should be directed to ward identifying signs that the patient has severe disease warranting admission or in-hospital observation.

Vital Signs

Tachycardia, postural hypotension, and hypotension could indicate dehydration. Patients who are triaged to home management should urinate at least every 6 hours.

The tourniquet test

Skin

Petechiae may be present.

• 

  The above picture is a rash typically associated with Dengue fever.

Mental Status

Lethargy and restlessness are warning signs that the patient should be monitored.

HEENT

Mucosal bleeding is a warning signs that the patient should be monitored.

Lungs

• Pleural effusion is a warning sign the capillary leak may be occurring and that the patient should be monitored.

Abdomen

• Abdominal pain or tenderness are warning signs that the patient should be monitored.
• Liver enlargment >2 cm is a warning signs that the patient should be monitored.
• Ascites is a warning signs that the patient should be monitored.

Extremities

• Pedal edema or evidence of fluid accumulation

• assessment of haemodynamic status (Textbox D); • checking for quiet tachypnoea/acidotic breathing/pleural effusion;

Appearance of the Patient

The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with thrombocytopenia and relative leukopenia.

There exists a WHO definition of dengue haemorrhagic fever that has been in use since 1975; all four criteria must be fulfilled:

1. Fever
2. Haemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
3. Thrombocytopaenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinaemia)

Dengue shock syndrome is defined as dengue haemorrhagic fever plus:

• Weak rapid pulse,
• Narrow pulse pressure (less than 20 mm Hg)

or,

• Hypotension for age;
• Cold, clammy skin and restlessness.