# Dengue Fever (Uncomplicated) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Guidelines for Diagnosis, Treatment, Prevention and Control of Dengue 2009 - Verified date: 2026-08 ## Verified against - 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". ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - ORS — oral.liquid ## Complete treatment card ```text DENGUE FEVER (UNCOMPLICATED) Sources: WHO Guidelines for Diagnosis, Treatment, Prevention and Control of Dengue 2009 Review status: REVIEWED against 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". (2026-08) 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 Source StatPearls "Dengue Fever" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 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 Peds 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.) 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) 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. Caution 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. Egypt 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 PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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. 3. ORS [add-on - not a substitute] Adult 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 Peds Encourage frequent small sips of oral fluids; maintain adequate urine output 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. Caution 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. Egypt GLUCOHYDRAN 10 SACHET. ARAB DRUG COM... 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 M... 120.00 EGP SANSO ORS SYRUP 140 ML AUG PHARMA 400.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)