Dengue fever: symptoms, platelet count, tests and when to go to hospital

Dengue is a viral infection spread by the Aedes mosquito, which bites mostly in the early morning and late afternoon. In Pakistan cases rise after the monsoon, roughly from August to November, with big outbreaks in Lahore, Rawalpindi, Islamabad, Karachi and Peshawar.

Most people recover at home in about a week. A small number develop severe dengue, which can be life-threatening if not treated in time. Knowing the warning signs is what matters most.

Symptoms

Dengue usually starts 4 to 10 days after the mosquito bite with:

• Sudden high fever.
• Severe headache and pain behind the eyes.
• Muscle, joint and bone pain (it is called haddi tor bukhar, "bone-break fever").
• Nausea, vomiting, loss of appetite.
• A skin rash, often a few days in.

The critical phase

The most dangerous time is often when the fever comes down, usually around day 3 to 7. Plasma can leak from blood vessels at this stage. A patient who "feels better because the fever is gone" can still get worse, so keep watching for warning signs for 48 hours after the fever settles.

Warning signs: go to hospital now

• Severe or constant stomach pain.
• Vomiting again and again, or unable to keep fluids down.
• Bleeding from gums or nose, blood in vomit or black stools.
• Very tired, restless or confused.
• Cold, clammy hands and feet, or passing very little urine.
• Difficulty breathing.

Call 1122 or go to the nearest hospital. See hospitals with 24-hour emergency.

Tests for dengue

• Dengue NS1 antigen: best in the first 1 to 5 days of fever.
• Dengue IgM / IgG antibodies: become positive from about day 5 onwards.
• CBC with platelet count: repeated, often daily, to follow the platelet count, white cells and haematocrit. A rising haematocrit with falling platelets is a warning sign. Read what a CBC shows.

Many labs offer home sample collection, which helps when the patient is weak. Compare labs in Lahore, Rawalpindi, Islamabad and Karachi.

About platelets

Normal platelets are about 150,000 to 400,000 per µL. In dengue they often fall, sometimes well below 100,000. A low platelet count alone is not always dangerous, and most patients do not need a platelet transfusion. Doctors decide on admission and treatment from the warning signs, haematocrit and the overall condition, not from one platelet number.

Treatment at home

There is no specific antiviral medicine for dengue. Care is supportive:

• Drink plenty of fluids: water, ORS, soups, lassi, fresh juices. Watch that the patient passes urine regularly.
• Rest.
• For fever and pain use paracetamol only, in the correct dose. See our paracetamol dose guide.
• Do not take ibuprofen, aspirin, diclofenac or other painkillers of this kind. They increase the risk of bleeding.
• Do not take steroids or antibiotics unless a doctor prescribes them; antibiotics do not work on viruses.

Papaya leaf extract and similar home remedies are widely used, but they do not replace medical care or the warning signs above.

Prevention

• Remove standing water at home weekly: coolers, flower pots, tyres, water tanks, AC trays.
• Use mosquito repellent, nets and window screens; wear long sleeves in the morning and evening.
• A person who had dengue before can get a more severe illness the second time, so take prevention seriously.