Dengue fever is a mosquito-borne viral infection that affects millions of people worldwide each year. While it is usually not life-threatening, in some cases, it can progress to a severe and potentially fatal condition. Dengue fever has three distinct stages – febrile, critical, and recovery – that come with its own set of symptoms, complications, and challenges.

Here explore the three stages of dengue fever with expert insights from Dr. Amitabha Saha, Head of Critical Care & Internal Medicine at AMRI Mukundapur.

The febrile stage is the initial phase of dengue fever. During this period, patients experience a sudden onset of high fever. Temperatures can soar up to a staggering 104 degrees Celsius, leaving individuals feeling extremely unwell. This intense fever is often accompanied by severe headaches, joint and muscle pain, and a rash that may resemble measles.

It's important to note that while the fever is a hallmark symptom of dengue, it is also a key differentiator from other mosquito-borne illnesses. However, as alarming as the fever may be, it is in the transition to the next stage that dengue fever becomes particularly perilous.

The transition from the febrile to the critical stage is the most dangerous phase of dengue fever, and Dr. Saha emphasizes that this stage can be life-threatening. One of the critical events during this phase is hematocrit rise, where the pack cell volume increases, leading to the thickening of the blood. This thickening can be dangerous as it drains fluids from the capillary cells.

Intriguingly, as the patient enters the critical stage, the temperature often takes an unexpected turn. It may drop below the average body temperature of 98.4 degrees Celsius, which can be confusing for both patients and healthcare providers. This drop in temperature is just one of the many complexities that dengue fever presents.

The critical stage of dengue fever can last for five to six days and is characterized by various complications, including:

1. Shock: One of the most severe consequences of dengue fever is the development of shock, where the patient's blood pressure drops to dangerously low levels

2. Internal Bleeding: Hemorrhagic manifestations may occur, leading to bleeding from the gums, nose, or internal organs

3. Organ Failure: Dengue fever can cause acute liver failure and failure of other vital organs, further complicating the patient's condition

4. Pancreatitis: Inflammation of the pancreas is another potential complication that can occur during this stage.

5. Meningitis: Although rare, dengue fever can also lead to meningitis, a condition involving inflammation of the membranes surrounding the brain and spinal cord.

Following the critical stage, patients enter the recovery phase. During this period, the fever subsides, and the body begins the process of re-absorbing fluids. However, this phase also poses its own set of challenges. One of the critical considerations during the recovery stage is fluid management.

Dr. Saha advises that patients need to be cautious about fluid intake. Excessive fluid intake can lead to fluid overload, which, in turn, can contribute to organ failure. Therefore, doctors often recommend limiting fluid intake during this phase to prevent complications.

Dengue fever is notorious for its ability to progress rapidly, especially during the critical stage. It is crucial for individuals to recognize the warning signs and seek medical attention promptly.

Some of the most noticeable warning signs of severe dengue fever include:

1. Severe Stomach Pain: Intense abdominal pain can be a sign of severe dengue fever and should not be ignored.

2. Persistent Vomiting: Repeated episodes of vomiting, particularly if they are accompanied by other symptoms, should raise concerns.

3. External Bleeding: Bleeding manifestations, such as bleeding gums or nosebleeds, should be taken seriously. Additionally, blood in urine, stools, or vomit is a concerning sign.

4. Internal Bleeding: Dengue fever can cause bleeding under the skin, which often appears as bruising. These skin manifestations should be evaluated by a healthcare professional.

5. Difficult or Rapid Breathing: Changes in respiratory patterns, such as rapid or labored breathing, are indicative of severe dengue and require immediate attention.

6. Fatigue: Excessive fatigue, beyond what is typical during the course of the illness, can be a sign of progressing severity.

Dr. Saha highlights that approximately one out of 20 dengue patients, or around five percent, go on to develop severe dengue fever. This statistic underscores the importance of timely medical intervention and careful monitoring during the course of the illness.

Preventing dengue fever is also a critical aspect of controlling its spread. This includes measures such as reducing mosquito breeding sites, using mosquito repellents and taking other precautions to avoid mosquito bites. Dengue fever is a challenging and potentially life-threatening illness with distinct stages that demand careful attention. The transition from the febrile to the critical stage is particularly critical, as complications can escalate rapidly.

It is essential for individuals in dengue-prone areas to be aware of the warning signs and seek medical help promptly when needed. The insights provided by Dr. Saha emphasize the importance of vigilance and prompt medical care to manage and mitigate the impact of dengue fever, ultimately reducing the risk of severe complications and fatalities.