00000000The management of DHF cases(4, 5, 6) is divided according to these three phases.

1. Febrile phase
(a) Screen all suspected dengue patients.

• Tourniquet test* is an important tool for early screening of dengue patients from other viral/bacterial illnesses. It should be done in all children with high fever, flushed face, and without any focal signs and symptoms of infection. A positive tourniquet test is > 10 dots/square inch. The tourniquet test is positive in 50% of the patients on the first day, in 60 - 70% on the second day and >90% on the third day onwards.
  

(b) Supportive and symptomatic treatment.

• Give paracetamol 10 mg/kg/dose prn T > 39oC q 4 - 6 hr., aspirin and ibuprofen are contraindicated.
  
• Apply tepid sponges if a patient still has high fever after a dose of paracetamol.
  · For nutritional support, advise soft diet, fruit juice, milk or ORS.
  

(c) If a suspected patient has signs of dehydration and had severe vomiting, give 5% D/N/2 to correct dehydration and discontinue IV fluid as soon as possible, preferably within 24 hours. If IV fluid cannot be discontinued, give only a minimal amount - about half of the maintenance amount.

(d) Follow all suspected dengue patients closely everyday from day 3 of their illness.
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* Tourniquet test is performed by inflating a blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for five minutes. Wait for one minute after the release of pressure before reading the test.

00000000During the febrile phase, it is difficult to differentiate between DF and DHF patients because they have almost the same clinical symptoms, except that maculopapular rash and myalgia/arthralgia are less frequent in DHF. So one has to follow carefully all suspected dengue infected patients until they are afebrile for 24 hours without the use of antipyretic. At the end of the febrile phase, DF patients will recover spontaneously while in DHF patients, the critical stage is reached. In mild DHF cases, the change in vital signs is minimal and transient. Patients will recover spontaneously or shortly after intravenous fluid administration. In more severe cases, the disease progresses rapidly into the stage of shock.