Delving into the dangers of dengue: Recognising the red flags of infection

In Singapore, the presence of a fever does not always indicate a common infection. Most people are not able to immediately discern the cause of a fever, and one should not hastily dismiss the possibility of dengue. Given the endemic nature of dengue in the country, no one is exempt from the risk of contracting this mosquito-borne disease and experiencing its hallmark symptom of a high fever.  

Ms Imelda Hong*, 38, was diagnosed with dengue after enduring elevated body temperature for several days. While she sought relief for her fever through the use of paracetamol, her sister, who had previously contracted dengue, required hospitalisation due to a significant drop in her blood platelet count.

RECOGNISING THE SYMPTOMS OF DENGUE

According to Dr Rakesh Lalchandani, a medical affairs principal scientist at Haleon, dengue symptoms usually appear four to seven days after the initial mosquito bite. 

The first indication of dengue is usually the sudden onset of a high fever of about 40 degrees Celsius, which can last from two to seven days. Said Dr Rakesh: “During the early stages of the disease, many dengue patients may not exhibit other accompanying symptoms.” 

Other dengue symptoms include skin rashes, nausea and vomiting, as well as mild bleeding from the nose or gums. Body aches and pain are also characteristic symptoms of dengue. 

To confirm a diagnosis, consult a doctor who will evaluate your symptoms, review your medical history and perform a blood test to detect the presence of the dengue virus. 

While the precise mechanisms behind dengue-induced pain are still being investigated, the most common type of pain associated with dengue occurs in the muscle and joints – particularly at the ankles, knees and elbows, said Dr Rakesh. Other forms of dengue-related discomfort include headaches and pain behind the eyes. 

“The experience of pain can vary among individuals,” he said. “Some people may encounter pain in specific areas, while others may have more widespread discomfort. The intensity of pain can also differ from person to person.” 

Undoubtedly, dengue can be a highly unpleasant ordeal. Not only does the disease affect a person’s ability to perform daily activities like going to work or school, post-infection fatigue has also been detected in some dengue patients. Said Dr Rakesh: “This may persist for up to two months, further impacting a person’s productivity and quality of life.” 

If a person suspects that they have dengue, it is important that they seek prompt medical attention, emphasised Dr Rakesh. 

WHAT HAPPENS AFTER A POSITIVE DENGUE DIAGNOSIS?

For individuals diagnosed with dengue and instructed to recover at home, Dr Rakesh recommends ample rest and drinking plenty of fluids to stay hydrated. 

Some people may reach for non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen to alleviate their fever and pain. However, according to the World Health Organization (WHO), NSAIDs should not be taken to treat dengue symptoms.

Dr Rakesh explained that NSAIDs are known to thin the blood and could worsen a dengue patient’s condition. He warned: “As dengue patients are at risk of haemorrhage, NSAIDs may potentially increase the risk of bleeding.” 

While there is no specific treatment for dengue, WHO reports that paracetamol is often used for fever and pain management. In Singapore, paracetamol is readily available, a common household brand being Panadol.

“When used as directed, paracetamol-based products are suitable for use in children and the elderly in managing dengue-related pain and fever,” said Dr Rakesh. “However, it’s important to adhere to the recommended dosage and consult a healthcare professional, particularly for pregnant woman. Read the label of the product before use, as varying strengths and formulations of paracetamol may entail different dosages.” 

WHEN DENGUE SYMPTOMS WORSEN

Dengue can sometimes progress to severe dengue, which is potentially life-threatening. People who experience a second dengue infection – like Ms Hong's sister – are at higher risk for severe dengue, says WHO. 

A low platelet count is a symptom of severe dengue, and may potentially lead to bleeding on and under the skin, organ impairment, shock and death.   

“The symptoms of severe dengue usually manifest one to two days after the high fever subsides,” said Dr Rakesh. “Typically, a temperature of 40 degrees Celsius is considered common for dengue. The warning signs of severe dengue can include a decrease in temperature to below 38 degrees Celsius (which is counterintuitive), along with severe abdominal pain, persistent vomiting and the presence of blood in vomit.” 

“With dengue cases on the rise in Singapore, vigilance is key – protect yourself by knowing how to spot the red flags. With proper medical care and early diagnosis, dengue case fatality rates are below 1 per cent,” said Dr Rakesh. 

Learn more about dengue fever and its management options. 

*The patient’s name has been changed to protect her privacy.