Dengue is a viral disease transmitted by the bite of a mosquito infected by dengue viruses. It is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome. Most patients recover following a self-limiting non-severe clinical course like nausea, vomiting, rash, aches and pains, but a small proportion progress to severe disease, mostly characterized by plasma leakage with or without haemorrhage, although severe haemorrhages or severe organ impairment can occur, with or without dengue shock.
Clinical warning signs are: abdominal pain or tenderness, mucosal bleeding, lethargy and /or restlessness, rapid decrease in platelet count, increase in hematocrit. Other signs can include: persistent vomiting, visible fluid accumulation, liver enlargement more than 2 cm.
Clinical signs include: 1. Severe plasma leakage leading to shock (Dengue shock syndrome - DSS) and/or fluid accumulation with respiratory distress; 2. Severe bleeding as evaluated by clinician; 3. Severe organ involvement: Liver AST or ALT >=1000, CNS: impaired consciousness (encephalitis), involvement of other organs, as myocarditis or nephritis