Approach to dengue fever

Dengue fever is a significant public health concern in tropical and subtropical regions. Its global burden has risen rapidly in recent years, with climate change driving its geographic expansion, including into parts of Europe. A systemic and dynamic disease, dengue follows a clinical course comprising febrile, critical, and recovery phases. Patients exhibiting warning signs—such as persistent vomiting, abdominal pain, and lethargy—are at higher risk of developing severe dengue, primarily due to severe plasma leakage and, less commonly, severe haemorrhage or organ impairment. The disease typically presents as an acute febrile illness, often with overlapping features of other tropical infections such as chikungunya, Zika, leptospirosis, rickettsiosis, typhoid fever, and malaria, complicating early diagnosis. Point-of-care detection of the nonstructural protein 1 antigen is valuable during early illness, whereas IgM and IgG serology aids diagnosis as the disease progresses. In the absence of specific therapeutics, management focuses on symptomatic relief, judicious fluid administration, and risk stratification to identify the 3–5% of patients who may progress to severe disease. Prevention relies on vector control and, more recently, vaccination, yet gaps remain in effective antivirals, host-directed therapies, and validated biomarkers. A thorough understanding of dengue pathophysiology and its dynamic progression is essential for robust case management to reduce morbidity and mortality.