Dengue — Clinical

A 35-year-old man from Delhi presents on day 5 of fever with sudden onset of severe epigastric pain, persistent vomiting, and lethargy. Vital signs: temperature 38.2°C, pulse 112/min (weak), blood pressure 98/65 mmHg, respiratory rate 24/min. Skin is warm and flushed. Laboratory: platelet count 28,000/μL, haematocrit 52% (baseline 42%), AST 580 U/L, ALT 240 U/L, albumin 2.8 g/dL. Chest X-ray shows bilateral pleural effusions. What is the most appropriate immediate management?

A 28-year-old man from Mumbai presents with fever, myalgia, and a petechial rash on day 6 of illness. Platelet count is 60,000/μL and AST is 320 U/L. Which is the most common site of haemorrhage in dengue haemorrhagic fever?

A 28-year-old man from Bangalore presents on day 7 of illness with high fever, petechial rash, bleeding gums, and haematocrit rise from 38% to 44%. Platelet count is 40,000/μL. He is haemodynamically stable with normal blood pressure. All of the following warrant urgent intervention in dengue haemorrhagic fever EXCEPT:

A 32-year-old woman from Delhi presents on day 5 of fever with severe abdominal pain, persistent vomiting, and a platelet count of 45,000/μL. Her haemoglobin is 14 g/dL, haematocrit 42%, and urine output is 800 mL in 24 hours. NS-1 antigen is positive. What is the most appropriate immediate next step in management?

A 28-year-old man from Mumbai is admitted on day 7 of dengue fever. He has recovered from fever, platelet count is now 120,000/μL (rising), haematocrit is 38% (down from 42% on admission), and urine output is 1.2 mL/kg/hr. He is haemodynamically stable. However, he now complains of severe headache and neck stiffness. CSF shows 120 cells/μL (90% lymphocytes), protein 80 mg/dL, glucose 55 mg/dL (serum glucose 110 mg/dL), and Gram stain is negative. What is the most appropriate next step?