infectious

Dengue Fever (Uncomplicated)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

WHO Guidelines for Diagnosis, Treatment, Prevention and Control of Dengue 2009

Verified against3 documents

WHO Guidelines for Diagnosis, Treatment, Prevention and Control of Dengue 2009
Dengue Fever - disease-level clinical article (dengue-fever-clinical.txt)
MSF Essential Drugs 2024 - paracetamol (oral): "Adult: 1 g 3 or 4 times daily (max. 4 g daily)" and "Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily)". The same entry carries a dengue reduction: "Reduce the dose in: ... patients with dengue with warning sign(s): Child: 10 mg/kg 3 to 4 times daily; Adult: 500 mg 3 to 4 times daily".

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

Illness follows a 4 to 10 day incubation period after the bite of an infected Aedes mosquito
Abrupt high fever of 38.5 C or more with severe headache, pain behind the eyes, marked muscle and joint aches, fatigue, and poor appetite [fatigue · fever · headache · joint pain · poor appetite]
Gastrointestinal symptoms are common and can dominate the picture, especially in children and those who go on to severe disease
A short-lived rash tends to show up two to six days after the fever begins, or during early recovery, and can itch [fever · itching · rash]
Minor bleeding such as pinpoint spots, easy bruising, nosebleed, or gum bleeding may occur, while major hemorrhage is uncommon in an uncomplicated case [bleeding · bruising · gum bleeding · nosebleed · petechiae]
A minority of patients show a two-humped saddleback fever pattern that should raise suspicion in an endemic area [fever]
Warning signs of progression include ongoing vomiting, worsening belly pain, lethargy or restlessness, mucosal bleeding, a rising hematocrit, and evidence of fluid buildup [abdominal pain · bleeding · irritability · lethargy · vomiting]
The shift toward severe disease often happens around days 4 to 6, just as the fever is breaking and the patient seems to be improving [fever]

Signs — what you find (9)

During the fever phase patients look acutely unwell with a flushed face and general malaise [fever · malaise]
Red eyes, a red throat, swollen lymph nodes, and diffuse muscle and joint tenderness are common exam findings [lymphadenopathy]
Skin findings range from diffuse redness to a macular, maculopapular, or pinpoint-spotted rash over the face, trunk, and limbs [rash · redness]
A positive tourniquet test, which checks capillary fragility, supports the diagnosis though its accuracy is limited
A tender, enlarged liver between days 3 and 7 is a recognized warning sign [hepatomegaly]
Rising heart rate, a narrowing gap between systolic and diastolic pressure, slow capillary refill, cool limbs, and a postural blood pressure drop can signal early shock despite a normal systolic reading [cold peripheries · shock · stricture]
Decreased breath sounds or crackles at the lung bases can reflect fluid around the lung, and the abdomen may show ascites [ascites · crackles · reduced air entry]
In severe disease the patient may show low blood pressure, confusion, low urine output, breathing difficulty, or overt bleeding [bleeding · breathlessness · confusion · hypotension]
During recovery a confluent red rash with small islands of normal, spared skin can appear and is often itchy [itching · rash]

Tests (12)

A 2009 WHO framework sorts cases into three tiers - no warning signs, warning signs present, and severe illness - to guide how closely a patient is watched
Warning signs include belly pain or tenderness, ongoing vomiting, fluid buildup, mucosal bleeding, lethargy, an enlarged liver, and a rising hematocrit alongside a fast-falling platelet count
Severe disease is defined by shock or respiratory distress from plasma leakage, major bleeding, or organ failure with transaminases at or above 1000 units per liter
A baseline complete blood count with platelets and hematocrit supports the diagnosis and sets a reference point for tracking plasma leakage
Watching the hematocrit climb while the platelet count falls is the key pattern that can precede shock
In the first week, RT-PCR is usually positive through day 5 and NS1 antigen testing through roughly day 4 to 7
NS1 antigen detects over 90 percent of first infections but only about 60 to 80 percent of second infections
IgM against dengue can be picked up from around day 4 of symptoms and supports a presumptive diagnosis
IgG rises later and at a lower titer in a first infection but climbs fast by day 3 to 4 with broader cross-reactivity in a second infection
Chest and abdominal ultrasound or chest x-ray can pick up pleural fluid and ascites, and ultrasound can detect leakage as early as day 3
A positive tourniquet test is commonly defined as 10 or more petechiae per 2.5 cm square after 5 minutes of cuff pressure midway between systolic and diastolic
The tourniquet test can be falsely negative during profound shock, so it should not be used alone to judge severity

If not this — what else fits (11)

Chikungunya more often causes frank arthralgia and specific joint swelling, whereas belly pain, leukopenia, bleeding, and low platelets lean toward dengue
Zika infection looks similar but is more often linked to conjunctivitis, and co-infection with dengue does occur
Oropouche virus causes an abrupt fever with severe headache, chills, and myalgia; only microbiologic testing separates it from dengue
Acute HIV seroconversion causes fever, rash, swollen nodes, sore throat, and myalgia, and is distinguished by an HIV antigen/antibody test
Leptospirosis classically brings fever, rigors, muscle pain, conjunctival suffusion, and headache, confirmed by serology
Typhoid fever can show fever, belly pain, rash, and sometimes a relatively slow pulse for the degree of fever, confirmed by blood or stool culture
Rickettsial infection can add an eschar and localized swollen nodes to the fever and rash picture in some syndromes
Bacterial sepsis presents with fever, a fast heart rate, and confusion, and needs prompt blood cultures
Malaria is confirmed by a rapid antigen test or by finding parasites on a blood smear
Other viral hemorrhagic fevers must be considered when bleeding is severe, and are told apart by exposure history and PCR or serology
Low white cells, low platelets, raised liver enzymes, and a relatively low CRP favor dengue over other febrile illnesses, though overlap is substantial

SourceStatPearls "Dengue Fever" - disease-level clinical article

Presentation findings are traced to the source above.

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (max. 4 g daily). Reduce to 500 mg 3 or 4 times daily in dengue with warning sign(s) x 5-7 days during febrile phase

Paediatric dose

10-15 mg/kg/dose [child max 500 mg]

(Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily). In dengue with warning sign(s), reduce to 10 mg/kg 3 to 4 times daily.)

Dose by weight
3kg	30-45 mg/dose
4kg	40-60 mg/dose
5kg	50-75 mg/dose
6kg	60-90 mg/dose
7kg	70-105 mg/dose
8kg	80-120 mg/dose
9kg	90-135 mg/dose
10kg	100-150 mg/dose
11kg	110-165 mg/dose
12kg	120-180 mg/dose
13kg	130-195 mg/dose
14kg	140-210 mg/dose
15kg	150-225 mg/dose
16kg	160-240 mg/dose
17kg	170-255 mg/dose
18kg	180-270 mg/dose
19kg	190-285 mg/dose
20kg	200-300 mg/dose
21kg	210-315 mg/dose
22kg	220-330 mg/dose
23kg	230-345 mg/dose
24kg	240-360 mg/dose
25kg	250-375 mg/dose
26kg	260-390 mg/dose
27kg	270-405 mg/dose
28kg	280-420 mg/dose
29kg	290-435 mg/dose
30kg	300-450 mg/dose
31kg	310-465 mg/dose
32kg	320-480 mg/dose
33kg	330-495 mg/dose
34kg	340-500 mg/dose (upper capped)
35kg	350-500 mg/dose (upper capped)
36kg	360-500 mg/dose (upper capped)
37kg	370-500 mg/dose (upper capped)
38kg	380-500 mg/dose (upper capped)
39kg	390-500 mg/dose (upper capped)
40kg	400-500 mg/dose (upper capped)
41kg	410-500 mg/dose (upper capped)
42kg	420-500 mg/dose (upper capped)
43kg	430-500 mg/dose (upper capped)
44kg	440-500 mg/dose (upper capped)
45kg	450-500 mg/dose (upper capped)
46kg	460-500 mg/dose (upper capped)
47kg	470-500 mg/dose (upper capped)
48kg	480-500 mg/dose (upper capped)
49kg	490-500 mg/dose (upper capped)
50kg	500 mg/dose (capped)

Dose source

MSF Essential Drugs 2024 - paracetamol (oral): "Adult: 1 g 3 or 4 times daily (max. 4 g daily)" and "Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily)". The same entry carries a dengue reduction: "Reduce the dose in: ... patients with dengue with warning sign(s): Child: 10 mg/kg 3 to 4 times daily; Adult: 500 mg 3 to 4 times daily".

Why

Antipyretic and analgesic for fever and pain in dengue fever, chosen because NSAIDs and aspirin are contraindicated in dengue due to the bleeding and plasma leakage risk.

Cautions

NSAIDs and aspirin are strictly CONTRAINDICATED due to severe bleeding and plasma leakage risk.
Monitor for warning signs of severe dengue: persistent vomiting, severe abdominal pain, mucosal bleeding, fluid accumulation, lethargy.
500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FEBRIMOL 500 MG 20 TAB.	PHARCO	3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.	MEMPHIS	8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.	MUP	13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.	EIPICO	24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.	UTOPIA	42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.	MISR	38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETS	JULPHAR	32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETS	AUG PHARMA	50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solid	PHARCO	4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	5.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Dengue Fever - disease-level clinical article (dengue-fever-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - The warning signs that mandate reassessment or escalation toward severe dengue are abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, hepatomegaly, and rising hematocrit with falling platelets.
RED FLAG - High-risk comorbidities and conditions (pregnancy, infancy, older age, diabetes, renal failure, obesity, hemolytic disorders, poor social situation) indicate that inpatient admission is needed even without other warning signs.
RED FLAG - Patients often feel better as fever breaks (defervescence) exactly when deterioration/shock risk is highest - a false-reassurance trap for both patient and clinician.

ORS

add-on - not a substitute

Formoral.liquid

Adult dose and duration

Make the sachet up to the volume printed on the pack - a WHO/UNICEF standard sachet makes 1 litre, and using less water than the label says makes the solution dangerously concentrated. Egypt also sells ready-mixed 240-360 mL packs, which need no dilution. Sip 2-3 L daily according to thirst and fluid loss. x 3-5 days during febrile phase

Paediatric dose

Encourage frequent small sips of oral fluids; maintain adequate urine output

Dose source

WHO Guidelines for Diagnosis, Treatment, Prevention and Control of Dengue 2009

Why

Adjunct oral fluid replacement to maintain hydration alongside close monitoring in uncomplicated dengue fever; it supports but does not replace escalation to IV fluids if signs of plasma leakage develop.

Cautions

Never make the solution up in less water than the pack states. A five-fold concentrated ORS given to a dehydrated patient causes hypernatraemia, and an infant is the one least able to survive it.
If patient cannot tolerate oral fluids or shows signs of plasma leakage, refer immediately for IV fluids.
Maintain oral fluid intake equal to normal daily maintenance plus losses.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
GLUCOHYDRAN 10 SACHET.	ARAB DRUG COMPANY (ADCO)	1.75 EGP
REHYDRAN N 10 SACHET	CID	4.50 EGP
REHYDRO ZINC 10 SACHETS	CID	7.00 EGP
ORS 20 SACHETS	PHAROPHARMA	40.00 EGP
ELECTRO MASH SYRUP 200 ML	MASH PREMIERE	60.00 EGP
FLEXOLYTE ORAL REHYDRATION SOL. 240 ML	KEMPETRO FOR CHEMICAL INDUSTRIES	65.00 EGP
HERO ORS 200 ML	HERO > HERO MEA TRADING	120.00 EGP
SANSO ORS SYRUP 140 ML	AUG PHARMA	400.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.