Dengue phases

Dengue infection may be a systemic and dynamic disease. it's a good clinical spectrum

that includes both severe and non-severe clinical manifestations. After the brooding period, the ailment starts suddenly and is trailed by the three stages febrile, basic, and recuperation. For a disease that's complex in its manifestations, management is comparatively simple, inexpensive, and effective in saving lives goodbye as correct and timely interventions are instituted. The key's early recognition and understanding of the clinical problems during the various phases of the disease, resulting in a rational approach to case management and an honest clinical outcome.

Activities at the first and secondary care levels are critical in determining the clinical outcome of dengue. 

Febrile phase

Patients typically develop high-grade fever suddenly. This acute febrile phase usually lasts 2–7 days and is usually amid facial flushing, skin erythema, generalized body ache, myalgia, arthralgia, and headache. Anorexia, nausea, and vomiting are common. It is often difficult to differentiate dengue clinically from non-dengue febrile diseases within the early febrile phase. A positive tourniquet test during this phase increases the probability of dengue. Additionally, these clinical features are indistinguishable between severe and non-severe dengue cases. 

Gentle haemorrhagic appearances like petechiae and mucosal layer dying (for example nose and gums) could likewise be seen. Massive vaginal bleeding (in women of childbearing age) and gastrointestinal bleeding may occur during this phase but isn't common. The liver is usually enlarged and tender after a couple of days of fever. The earliest abnormality within the origin count may be a progressive decrease in total leukocyte count, which should alert the physician to a high probability of dengue.

Critical phase

Around the time of defervescence, when the temperature drops to 37.5C–38C or less and remains below this level, usually on days 3–7 of illness, a rise in capillary permeability in parallel with increasing hematocrit levels may occur. This marks the beginning of the critical phase. the amount of clinically significant plasma leakage usually lasts 24–48 hours. Dynamic leukopenia followed by a quick lessening in platelet check normally goes before plasma spillage. At now patients without an ascent in slender penetrability will improve, while those with expanded fine porousness may go to pot because of lost plasma volume. The degree of plasma leakage varies. Pleural effusion and ascites could also be clinically detectable counting on the degree of plasma leakage and

the volume of fluid therapy. Hence chest x-ray and abdominal ultrasound are often useful tools for diagnosis. Shock is often preceded by warning signs. The blood heat could also be subnormal when shock

occurs. With a prolonged shock, the resultant organ hypoperfusion leads to progressive

organ impairment, acidosis, and disseminated intravascular coagulation. This

in turn results in severe hemorrhage causing the hematocrit to decrease in severe

shock. 

Those who improve after defervescence are said to possess non-severe dengue. Some

patients reach the critical phase of plasma leakage without defervescence.

Recovery phase

 Some patients may have a rash of “isles of white

in the sea of red”. Some may experience generalized pruritus. Bradycardia and

electrocardiographic changes are common during this stage.

The hematocrit stabilizes or could also be lower thanks to the dilutional effect of reabsorbed

fluid. White blood corpuscle count usually starts to rise soon after defervescence but the

recovery of platelet count is usually later than that of white blood corpuscle count. During the critical and/or recovery

phases, excessive fluid therapy is related to pulmonary oedema or congestive heart failure.

Severe dengue

As dengue vascular permeability progresses, hypovolaemia worsens and leads to shock. it always takes place around defervescence, usually on day 4 or 5 days. Uniquely, the diastolic

pressure rises towards the blood pressure and therefore the pulse pressure narrows because of the peripheral vascular resistance increases. Patients in dengue shock often remain conscious

and lucid. The inexperienced physician may measure traditional blood pressure and

misjudge the critical state of the patient. Finally, there's decompensation and both

pressures disappear abruptly. Prolonged hypotensive shock and hypoxia may cause multi-organ failure and a particularly difficult clinical.

The patient is taken into account to possess shock if the heartbeat pressure (i.e. the difference between

the systolic and diastolic pressures) is ≤ 20 torr in children or he/she has signs

of poor capillary perfusion. In adults, the heartbeat pressure of ≤ 20 torrs may indicate a more severe shock. Massive bleeding may occur without prolonged shock in

instances when aspirin (aspirin), ibuprofen or corticosteroids are 

taken.

Severe dengue should be considered if the patient is from a neighborhood of dengue risk

presenting with fever of 2–7 days plus any of the subsequent features:

 • there's evidence of plasma leakage, such as:

 – high or progressively rising hematocrit;

 – pleural effusions or ascites;

 • there's significant bleeding.

 • there's an altered level of consciousness (lethargy or restlessness, coma, 

 convulsions).

 • there's severe gastrointestinal involvement (persistent vomiting, increasing or intense abdominal pain, jaundice).

 • there's severe organ impairment (acute liver failure, acute kidney failure, 

 encephalopathy or encephalitis, or other unusual manifestations, cardiomyopathy)

 or other unusual manifestations