A 5-year-old boy from an endemic district in West Bengal presents with fever, headache, and myalgia for 5 days. Rapid diagnostic test (RDT) is positive for dengue NS1 antigen. He is alert, has a platelet count of 80,000/μL, and haematocrit is 38%. What is the most appropriate next step in management?

Explanation

## Management of Dengue Fever — Early Phase **Key Point:** Dengue management is risk-stratified. This child is in the **febrile phase** with **warning signs** (thrombocytopenia <100,000/μL) but without severe dengue criteria, requiring close inpatient monitoring. ### Dengue Severity Classification | Category | Features | Management | |----------|----------|-------------| | **Dengue without warning signs** | Fever + ≥2 of: headache, myalgia, rash, leucopenia | Outpatient, oral rehydration, daily follow-up | | **Dengue with warning signs** | Platelet <100,000/μL, rising haematocrit, lethargy, persistent vomiting, hepatomegaly, bleeding | **Inpatient admission, IV access, daily monitoring** | | **Severe dengue** | Plasma leakage (shock, ascites), severe bleeding, organ failure | ICU, aggressive fluid resuscitation, transfusion | **High-Yield:** This patient has **warning signs** (platelet 80,000/μL) → **requires inpatient admission** for daily monitoring of platelets and haematocrit to detect progression to critical phase (days 3–7 of illness). ### Management Algorithm ```mermaid flowchart TD A[Dengue RDT positive]:::outcome --> B{Presence of warning signs?}:::decision B -->|No| C[Outpatient management]:::action C --> D[Oral rehydration + daily follow-up] B -->|Yes| E[Admit for inpatient care]:::action E --> F[Daily platelet & haematocrit monitoring] E --> G[IV access, supportive care] F --> H{Progression to critical phase?}:::decision H -->|No| I[Discharge after 48 hrs afebrile]:::outcome H -->|Yes| J[Aggressive fluid resuscitation, transfusion]:::urgent ``` **Clinical Pearl:** The critical phase (days 3–7) is when plasma leakage peaks. Daily monitoring of platelet count and haematocrit is essential to detect early signs of shock (rising haematocrit despite fluid loss, falling platelet count). Platelet transfusion is reserved for active bleeding or platelet count <20,000/μL. **Warning:** Corticosteroids (dexamethasone) are NOT indicated in dengue unless there is dengue shock syndrome with refractory hypotension. They do not prevent progression and may worsen outcomes. Prophylactic platelet transfusion is harmful and increases thrombosis risk.