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Symptoms to Observe in Regular to Severe Dengue

Types of Dengue Fever

Dengue is hyperendemic in Malaysia.[1] ‘Hyperendemic’ means that Malaysia sees a high and persistent level of dengue cases.[2] 2019 was the worst year of reported dengue cases in Malaysia, with 130,101 cases reported.[3] ​

Dengue virus is transmitted by Aedes mosquitoes, which bite mainly during the day, usually early in the morning and in the evening before dusk.[4] Symptoms of dengue may appear 4-10 days after a person catches the dengue virus.[4] As there are four types of dengue, it is possible to be infected by dengue up to 4 times throughout your lifetime.[1] A second infection caused by a different virus serotype may increase your risk of severe dengue.[1],[4]

While most dengue infections may not present with any symptoms (known as asymptomatic), symptomatic dengue may be broadly classified into dengue (with and without warning signs) and severe dengue.[4]

Severe dengue symptoms may emerge after the fever has subsided.[4] Therefore, it is important to look out for early warning signs to seek medical attention early.

Symptoms of Dengue

Symptoms of dengue may last 2 to 7 days from when it begins.[4] Dengue symptoms often vary for each individual and may include:[1],[4]

  • Fever (high temperature usually up to 40 °C)
  • Headache
  • Pain behind the eyes
  • Muscle and joint pain
  • Nausea and vomiting
  • Swollen glands
  • Rash

Early Warning Signs of Severe Dengue

Severe dengue may be fatal due to plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ dysfunction.[5] As there may be a wide range of symptoms for severe dengue,[6] it is important to seek medical attention early or when unsure.

Dengue hemorrhagic fever (DHF) is one presentation of severe dengue that is characterised by complications such as:[7]

  • High fever
  • Bleeding (haemorrhage)
  • Enlarged liver (hepatomegaly)
  • Circulatory failure (in severe cases)

Early warning signs of DHF may develop in dengue patients within 3-5 days of initial dengue symptoms.[7] These symptoms may include:[7]

  • Bleeding
  • Difficulty breathing (pleural effusion)
  • Restlessness
  • Vomiting
  • Abdominal pain
  • Sudden temperature drop

Dengue shock syndrome (DSS) or shock can happen in dengue patients as the result of severe plasma leakage.[6],[8] DSS is characterised by:[8]

  • Pulse is fast but weak
  • Low blood pressure (hypotension)
  • Reduced perfusion (delayed capillary refill time)
  • Cold and clammy skin
  • Restlessness

Summary of Early Warning Signs

If you or your family member have dengue, seek medical attention immediately should their body temperature drop below 38 °C during the critical period (often occurs between day 3 to 6 of the start of symptoms) and any one of the following symptoms develop:[4],[6],[9]

  • Severe stomach ache
  • Persistent vomiting
  • Rapid breathing
  • Bleeding gums
  • Blood vomiting
  • Fatigue
  • Restlessness
  • Excessive sleepiness

While there is no specific cure for dengue,[4] early diagnosis and medical attention may reduce rates of dengue-related complications and death.[8]

To reduce your risk of getting dengue or severe dengue, prevention is best. Read the following articles to learn about clearing your living area of mosquito breeding sites and preventing mosquitoes from biting your loved ones.

References

  1. Kaur. J. Demam Denggi. Portal | Link | Accessed on September 23, 2022
  2. Rathakrishnan A, et al. (2014) Clinical and Immunological Markers of Dengue Progression in a Study Cohort from a Hyperendemic Area in Malaysia. PLoS ONE 9(3): e92021 | Link | Accessed on September 23, 2022
  3. CodeBlue. (2020, January 6). Malaysia reports 130,000 dengue cases in 2019, highest since 2015 | Link | Accessed on September 23, 2022
  4. World Health Organisation. Dengue and Severe Dengue | Link | Accessed on September 23, 2022
  5. World Health Organisation - Western Pacific Region. | Link | Accessed on September 23, 2022
  6. Ministry of Health Malaysia. Clinical Practice Guideline - Management of Dengue Infection In Adults (Third Edition) | Link | Accessed on September 23, 2022
  7. Wang, W.-H., et al. (2020). Dengue hemorrhagic fever – a systemic literature review. Journal of Microbiology, Immunology and Infection | Link | Accessed on September 28, 2022
  8. World Health Organization. (1970). Comprehensive guideline for prevention and control of Dengue | Link | Accessed on September 23, 2022
  9. Centers for Disease Control and Prevention. Dengue Clinical Presentation | Link | Accessed on September 23, 2022

This article is brought to you by Takeda Malaysia Sdn. Bhd.

Disclaimer: This information is available to the public for information purposes only; it should not be used for diagnosing or treating a health problem or disease. It is not intended as a substitute for consultation with a healthcare provider. Please consult your healthcare provider for advice.

C-ANPROM/MY/DENV/0387 March 2025

Written By Sean Koh, Bachelor of Medicine, Bachelor of Surgery, Bachelor of Obstetrics - MB, BCh, BAO (Hons) - National University of Ireland on

Reviewed By DoctorOnCall Panel Doctor