What Are the Signs of Dengue Fever?

Last Editorial Review: 9/24/2018

Ask the experts

I have been traveling in sub-Saharan Africa recently, and I've started to feel body aches and fatigue over the last day or so. What are the warning signs of dengue fever?

Doctor's response

The diagnosis of dengue fever is usually made when a patient exhibits the typical clinical symptoms of headache, high fever, eye pain, severe muscle aches, and petechial rash and has a history of being in an area where dengue fever is endemic. Dengue fever can be difficult to diagnose because its symptoms overlap with those of many other viral illnesses, such as West Nile virus and chikungunya fever.

Health care professionals may use a blood test called the DENV Detect IgM Capture ELISA to diagnose people with dengue fever. The FDA notes that the test may also give a positive result when a person has a closely related virus, such West Nile disease.

Dengue fever starts with symptoms of chills, headache, pain in the back of the eyes that may worsen upon moving the eyes, appetite loss, feeling unwell (malaise), and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relatively low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The lymph nodes in the neck and groin are often swollen.

High fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic itchy rash (small red spots, called petechiae) appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

Dengue fever is common in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases.

Ahmad, Nisar, et al. "Dengue Fever Treatment With Carica papaya Leaves Extracts." Asian Pac J Trop Biomed 1.4 Aug. 2011: 330-333.

Anwar, Sarah. "First Dengue Vaccine Approved By WHO After Twenty Years of Clinical Studies." ContagionLive.com. Apr. 19, 2016. <http://www.contagionlive.com/news/first-dengue-vaccine-is-approved-by-who-after-twenty-years-of-clinical-studies?utm_source=Informz&utm_medium=Contagion+Live&utm_campaign=Contagion_Live_

Canada. Public Health Agency of Canada. "Dengue Fever: Global Update." June 3, 2011. <http://www.phac-aspc.gc.ca/tmp-pmv/thn-csv/dengue-eng.php>.

Canada. Public Health Agency of Canada. "Dengue in South East Asia." Aug. 23, 2007. <http://www.phac-aspc.gc.ca/tmp-pmv/2007/dengue070823_e.html>.

"Dengue Fever in Key West." Florida Department of Health. <http://www.doh.state.fl.us/Environment/medicine/arboviral/Dengue_FloridaKeys.html>.

Dengue Vaccine Initiative. <http://www.denguevaccines.org/>.

Effler, P.V., et al. "Dengue Fever, Hawaii, 2001-2002." Emerg Infec Dis 11.5 May 2005: 742-749. <http://www.ncbi.nlm.nih.gov/pubmed/15890132>.

Hendrick, Bill. "FDA OKs Test for Dengue Fever." WebMD.com. Apr. 13, 2011. <https://www.webmd.com/news/20110413/fda-oks-test-for-dengue-fever>.

New Zealand. Auckland Regional Public Health Service. "Dengue Fever, Zika & Chikungunya." September 2015. <http://www.arphs.govt.nz/health-information/communicable-disease/dengue-fever-zika-chikungunya#.VgB53HvBdgo>.

Seet, Raymond C.S., Amy M.L. Quek, and Erle C.H. Lim. "Post-infectious fatigue syndrome in dengue infection." Journal of Clinical Virology 38 (2007): 1-6. <

Shepherd, Suzanne Moore. "Dengue." Medscape.com. Oct. 5, 2015. <http://emedicine.medscape.com/article/215840-overview#a6>.

Switzerland. World Health Organization. "Dengue and Severe Dengue." April 2016.<http://www.who.int/mediacentre/factsheets/fs117/en/>.

Switzerland. World Health Organization. "Dengue Fever -- Sri Lanka." July 19, 2017. <http://www.who.int/csr/don/19-july-2017-dengue-sri-lanka/en/>.

Switzerland. World Health Organization. "Dengue vaccine research." Dec. 14, 2015. <http://www.who.int/immunization/research/development/dengue_vaccines/en/>.

Switzerland. World Health Organization. "Planning Social Mobilization and Communication for Dengue Fever Prevention and Control." <http://www.who.int/tdr/publications/publications/pdf/planning_dengue.pdf>.

Switzerland. World Health Organization. "Vector-Borne Viral Infections." <http://www.who.int/vaccine_research/diseases/vector/en/index.html>.

United States. California Department of Public Health. "Aedes aegypti and Aedes albopictus Mosquitoes." <https://www.cdph.ca.gov/HEALTHINFO/DISCOND/Pages/Aedes-albopictus-and-Aedes-aegypti-Mosquitoes.aspx>.

United States. Centers for Disease Control and Prevention. "Chikungunya." Oct. 6, 2010. <http://www.cdc.gov/ncidod/dvbid/chikungunya/>.

United States. Centers for Disease Control and Prevention. "Dengue." June 15, 2015. <http://www.cdc.gov/Dengue/>.

United States. Centers for Disease Control and Prevention. "Dengue." Oct. 28, 2010. <http://www.cdc.gov/dengue/epidemiology/index.html>.

United States. Centers for Disease Control and Prevention. "Dengue Hemorrhagic Fever --- U.S.-Mexico Border, 2005." Aug. 8, 2007. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a1.htm>.

United States. Centers for Disease Control and Prevention. "Locally Acquired Dengue -- Key West, Florida, 2009-2010." Morbidity and Mortality Weekly Report 59.19 May 21, 2010: 577-581. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5919a1.htm>.

United States. State of Hawaii, Department of Health. "Dengue Outbreak 2015." Jan. 8, 2016. <http://health.hawaii.gov/docd/dengue-outbreak-2015/>.

"Why a Vaccine." Dengue Vaccine Initiative. <http://www.denguevaccines.org/why-a-vaccine>.