Dengue is a mosquito-borne viral infection transmitted mainly by Aedes mosquitoes. Transmission commonly increases during and after the rainy season because stagnant water provides breeding sites, while warm and humid conditions favour mosquito reproduction.

In cities, dengue can occur around our homes, apartments and workplaces. Prevention is therefore not only about avoiding mosquitoes outdoors—it also requires eliminating stagnant water in our surroundings.

How do you recognise dengue?

Dengue often begins suddenly with:

• High fever
• Severe headache
• Pain behind the eyes
• Muscle and joint pains
• Marked tiredness
• Nausea or vomiting
• Loss of appetite
• Sometimes a skin rash

When should you be worried?

Most dengue infections recover with appropriate supportive care. However, some patients can develop severe dengue, particularly around the time the fever starts coming down.

This is also when warning signs may be missed. Families may feel reassured because the fever is improving, while the illness is actually entering its most dangerous phase.

Seek urgent medical attention if a person with suspected or confirmed dengue develops:

• Severe or persistent abdominal pain
• Repeated vomiting 
• New or worsening loose stools, especially when accompanied by  weakness or dehydration
• Blood in vomit or stool, or black stools
• Bleeding from the nose or gums
• Excessive sleepiness, restlessness or confusion
• Difficulty breathing
• Cold, clammy extremities
• Severe weakness, fainting or dizziness
• Reduced urine output

Vomiting and loose stools should not be dismissed.

Vomiting and diarrhoea, commonly described as loose stools, are often mistaken for a separate stomach infection or food poisoning. In a person with dengue, however, they can rapidly worsen dehydration and make it difficult to replace lost fluids.

Repeated vomiting is a recognised dengue warning sign. Loose stools may also contribute to significant fluid and electrolyte loss, particularly in children, older adults, pregnant people and those with other medical conditions. Do not assume these symptoms are harmless simply because there is no bleeding or because the fever is improving.

These warning signs can indicate plasma leakage, bleeding, dehydration or evolving shock and require prompt medical assessment.

Remember: a patient can become seriously ill even when the fever is coming down. The period around defervescence deserves particular attention.

What should you DO?

1. Maintain adequate hydration.

Offer fluids regularly unless a doctor has advised fluid restriction because of another medical condition.

Water, oral rehydration solutions, soups and other appropriate fluids can help maintain hydration. If vomiting or loose stools are present, small, frequent sips may be better tolerated than large amounts at once.

Do not force fluids if the person is repeatedly vomiting, drowsy or unable to swallow safely. Seek medical care instead.

 2. Follow-up matters.

Follow the doctor’s advice of serial platelet monitoring. 

A single CBC does not tell the whole story. The trend and the clinical condition are more important than one isolated platelet value.

 3. Eat as tolerated.

There is no special “dengue diet” that cures the infection. Take easily digestible, nutritious food according to your appetite.

 4. Prevent mosquito bites.

A person with dengue can still infect mosquitoes that bite them. Those mosquitoes can subsequently transmit dengue to other people.

Use mosquito repellents, screens, protective clothing and mosquito nets when appropriate.

 5. Remove stagnant water.

Regularly check:

– Flowerpots and trays

– Buckets and containers

– Coolers

– Roofs and terraces

– Construction areas

– Discarded tyres

– Any container that can collect rainwater

What should you NOT do?

1. Don’t self-medicate with ibuprofen or aspirin.

These medicines can increase bleeding risk and should generally be avoided when dengue is suspected.

For fever, paracetamol is generally preferred, using the appropriate dose and avoiding overdose.

 2. Don’t start antibiotics on your own.

Dengue is caused by a virus. Antibiotics do not treat dengue unless a doctor identifies a bacterial infection requiring antibiotic treatment.

3. Don’t dismiss vomiting or loose stools as “just a stomach bug”.

In someone with suspected or confirmed dengue, repeated vomiting or significant diarrhoea can quickly lead to dehydration and may occur alongside other warning signs.

 4. Don’t panic over every platelet drop.

A falling platelet count needs medical interpretation in the context of the patient’s overall condition. Platelet count alone should not determine whether a patient is improving or deteriorating.

 5. Don’t wait for severe bleeding.

Dengue can become serious because of plasma leakage, dehydration and shock—not just because of visible bleeding.

If warning signs develop, seek medical attention immediately.

The simple dengue rule

Fever → Think dengue when appropriate → Get assessed → Monitor closely → Watch for vomiting, loose stools, bleeding and other warning signs → Hydrate appropriately → Avoid NSAIDs → Prevent mosquito bites.

Most patients recover completely with appropriate supportive care. The key is early recognition and timely medical attention when warning signs appear.

Dr. Smitha B V
MBBS, DNB (Internal Medicine)
Consultant – Internal Medicine at Prakriya Hospitals.