Dengue fever physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The classic picture of Dengue Fever includes a high fever with no localizing source of infection on physical examination, with petechia being present occasionally. The physical examination in Dengue fever should be directed toward identifying signs that the patient has severe disease warranting admission or in-hospital observation.
Vital Signs
Pulse and Blood Pressure
Tachycardia, postural hypotension, a narrow pulse pressure (<20 mm Hg) and / or frank hypotension could indicate intravascular volume depletion due to either dehydration or capillary leak. The presence of any of the above is a warning sign of severe disease, and the patient should be hospitalized for observation.
Urine Output
If the patient is not urinating at least every 6 hours, this may reflect intravascular volume depletion due to capillary leak, and the patient should be observed for the development of severe disease.
Skin
If the patient has poor perfusion, the skin may be cold and clammy.
Petechiae may be present. The tourniquet test can used to elicit petechia. A blood pressure cuff is applied and inflated to a point between the systolic and diastolic blood pressures for five minutes. The test is positive if there are more than 20 petechiae per square inch (a petechia is a small red or purple spot on the body, caused by a minor hemorrhage).
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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 for the development of severe disease.
HEENT
Mucosal bleeding is a warning sign that the patient may have thrombocytopenia, and should be monitored for the development of severe disease.
Lungs
- Pleural effusion is a warning sign the capillary leak may be occurring and that the patient should be monitored for the development of severe disease.
Abdomen
- Abdominal pain or tenderness are warning signs that the patient should be monitored for the development of severe disease.
- Liver enlargment >2 cm is a warning signs and the patient should be monitored for the development of severe disease.
- Ascites is a warning sign and the patient should be monitored for the development of severe disease.
Extremities
- Pedal edema or evidence of fluid accumulation