Case 43. An 8-Year-Old with Fever, Headache, Muscle Ache, and Retro-Orbital Pain, Followed by Frequent Vomiting: Dengue Fever with Shock

Pediatric dengue patients usually present nonspecific symptoms/signs or viral syndrome, and typical skin rashes appear late in a clinical course. The tourniquet test, a marker of capillary fragility, can be used as a triage tool to differentiate dengue patients from those with other viral syndromes. According to the revised 2009 WHO case definitions, dengue illness can be classified into dengue without and with warning signs and severe dengue. Laboratory confirmation of acute dengue infection includes positive RT-PCR and lateral flow immunoassay for NS1 or anti-DENV IgM results. First dengue virus infection, or passively acquired dengue antibodies, may increase the severity of the subsequent dengue virus infection of different serotypes, an immunopathological phenomenon named antibody-dependent enhancement. Successful management of dengue vascular permeability syndrome relies on careful manipulation of parenteral fluids and colloids and proactive management of significant bleeding during the critical phase.