Dengue fever physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical Examination
The physical examination should include: • assessment of mental state; • assessment of hydration status; • assessment of haemodynamic status (Textbox D); • checking for quiet tachypnoea/acidotic breathing/pleural effusion; • checking for abdominal tenderness/hepatomegaly/ascites; • examination for rash and bleeding manifestations; • tourniquet test (repeat if previously negative or if there is no bleeding manifestation).
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The above picture is a rash typically associated with Dengue fever.
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:
- Fever
- Haemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
- Thrombocytopaenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
- 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.