Abstract
Dengue outbreaks in low- and middle-income countries contribute to significant hospital burden and preventable deaths. Early diagnosis and severity assessment are crucial to reduce unnecessary hospitalisation and prevent dengue-related complications. This standard operating protocol outlines a practical approach to diagnosis, triage, and fluid management based on current evidence and expert consensus. Hospitalisation and intravenous fluids are recommended for patients with warning signs, plasma leakage, or severe dengue. Judicious fluid administration is essential to avoid complications from both under- and over-resuscitation.
Flowchart Algorithm: Diagnosis
N.B.: aTourniquet test: ≥10 petechiae in a 1 inch² area after 5 min cuff inflation at the midpoint between systolic and diastolic blood pressure. bRapid tests (NS1, IgM/IgG) vary in sensitivity and specificity; confirm with laboratory-based enzyme-linked immunosorbent assay when feasible. cPaired sera testing: Acute sample (within first 7 days) + convalescent sample (≥1 week later) helps confirm dengue by IgM or IgG seroconversion or four-fold rise of IgG.
Flowchart Algorithm: Severity Assessment
aFebrile phase: Day 1–3/4; Critical phase: Day 3–6/7; Recovery phase: Day 6–10. Most complications (e.g. plasma leakage, shock, and bleeding) occur during the critical phase.
bShock is defined as evidence of impaired tissue perfusion (e.g. cool extremities, capillary refill ≥ 3 s, weak pulse, decreasing urine output, or elevated serum lactate) with or without low BP (i.e. hypotensive or compensated shock, respectively).
Abbreviations: ALT: alanine transaminase; AST: aspartate transaminase; FBC: full blood count; NSAIDs: non-steroidal anti-inflammatory drugs; ORS: oral rehydration solution; ICU: intensive care unit.
Flowchart Algorithm: Inpatient Management
N.B.:
•Avoid IV fluids in stable patients who tolerate oral intake and have no haemoconcentration, bleeding, or tissue hypoperfusion. Use passive leg raise test to assess fluid responsiveness when volume status is unclear, particularly in ICU settings Goal: Restore perfusion while minimising the risk of fluid overload. •Do not transfuse platelets solely for low counts (even <10 × 109/L) unless there is active bleeding or a planned invasive procedure. •Routine use of steroids and antimicrobials is not recommended.
Abbreviations: NS, normal saline; RL, Ringer's lactate; IV, intravenous.
Footnotes
Author contributions
The author conceived the idea and drafted and revised the manuscript.
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
