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Dengue

Last updated: July 9, 2025

Summarytoggle arrow icon

Dengue is a viral disease transmitted by mosquitoes (especially Aedes aegypti), most commonly in tropical regions. Most individuals with dengue are asymptomatic or have mild symptoms of fever, headache, and rash. Severe illness is rare; manifestations include pleural effusions, ascites, and hemorrhage. The typical course consists of the febrile phase, the critical phase, and the recovery phase; most affected individuals improve during the critical phase, but some develop severe dengue. Patients are risk-stratified, with hospitalization indicated for patients who have or are at risk of severe dengue. Treatment is supportive. Insect bite prevention methods are indicated to prevent further spread of disease and are recommended for all individuals who live in and/or travel to endemic areas.

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Epidemiologytoggle arrow icon

  • Distribution
    • Tropical regions worldwide, particularly Asia (e.g., Thailand) and the Americas
    • In the US, dengue is:
      • Endemic in some territories (e.g., Puerto Rico, American Samoa, the US Virgin Islands) [1]
      • Occasionally locally transmitted in Florida, California, Texas, Hawaii, and Arizona [2]
  • Incidence
    • Most common viral disease affecting tourists in tropical regions
    • ∼ 400 million infections per year worldwide
    • Severe dengue occurs in ∼ 2% of cases. [3]

References:[4]

Epidemiological data refers to the US, unless otherwise specified.

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Etiologytoggle arrow icon

A fifth dengue subtype (DENV 5), similar to varieties that normally infect wildlife, was recorded in Malaysia in 2013. Further research is needed to confirm this finding. [8]

References: [9]

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Clinical featurestoggle arrow icon

Most infected individuals are asymptomatic or have mild symptoms. [7]

Febrile phase of dengue [6][10]

Consider dengue if symptoms develop within 2 weeks of returning from a dengue-endemic region. [2]

Critical phase of dengue [6][7][10]

Severe dengue can occur in the absence of warning signs. [7]

Recovery phase of dengue [6][10]

  • Typically lasts 48–72 hours
  • General clinical improvement
  • Resorption of extravasated fluids leads to hemodynamic stability and diuresis.
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Classificationtoggle arrow icon

Probable dengue [7]

Fever with ≥ 2 of the following features, in an individual who lives in or has traveled to an endemic area:

Dengue with warning signs [7]

Severe dengue (formerly dengue hemorrhagic fever) [6][7]

Second infection with a different dengue serotype (especially serotype 2) is a risk factor for severe dengue, as it may cause an antibody-dependent reaction. [6][7]

Expanded dengue syndrome [14]

  • Uncommon atypical presentation
  • Isolated severe organ involvement (e.g., liver, kidney, heart, eyes, or brain)
  • Can occur in the absence of plasma leakage
  • May result from prolonged shock
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Diagnosistoggle arrow icon

Diagnostics occur alongside initial management of dengue. [15]

Approach [15][16][17]

Interpret results with caution in patients with previous exposure to dengue or other flaviviruses (including through vaccination) because of the risk of false positives. [17]

Dengue is a nationally notifiable disease in the US; report all suspected cases to the health department. [2]

Confirmatory studies

≤ 7 days after symptom onset [15][16][17]

> 7 days after symptom onset [15][17]

  • Preferred test: ELISA to detect IgM antibodies
  • NAAT can be used to confirm but cannot rule out dengue infections. [17]

Alternative tests

  • If standard confirmatory studies are not available, use paired IgM and IgG serology, taken during the acute and convalescent phases.
  • A 4-fold increase in IgG suggests infection.
  • Previous exposure to dengue or other flavaviruses (including through vaccination) may cause false-positive results; interpret results with caution.

Additional studies

The following laboratory findings support a diagnosis of dengue infection:

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Managementtoggle arrow icon

For further information on management in pregnant individuals and children, see “Special patient groups.”

Approach [10][13]

Avoid NSAIDs, including aspirin, as they may worsen hemorrhage and gastritis. [10][16]

Steroids, immunoglobulins, and antivirals are not indicated in the treatment of dengue. [12][16]

Immediate stabilization for patients with dengue

IV fluid therapy [13]

Consider a reduced fluid resuscitation regimen for patients at higher risk of fluid overload (e.g., heart failure, older adults, pregnant individuals). [13]

Management of hemorrhage [13]

Admission criteria for patients with dengue [12][13]

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Inpatient managementtoggle arrow icon

Routine laboratory monitoring for renal, hepatic, and clotting dysfunction is typically unnecessary in the absence of suggestive symptoms. [7]

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Outpatient management of denguetoggle arrow icon

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Differential diagnosestoggle arrow icon

Severe hemorrhagic manifestations with shock and death as well as decreased neutrophil and platelet counts are more indicative of dengue fever than chikungunya fever.

The differential diagnoses listed here are not exhaustive.

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Preventiontoggle arrow icon

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Special patient groupstoggle arrow icon

Dengue in infants and children [10]

Children are at increased risk of severe dengue compared to adults. [7]

Dengue in pregnancy [10][13][22]

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