Dengue without warning signs — DTM&H MCQ

Correct answer: C — Outpatient management with oral fluids, paracetamol, and daily review

The correct answer is C, outpatient management with oral fluids, paracetamol, and daily review. This patient has classic dengue fever (fever, retro-orbital pain, myalgia, maculopapular rash, positive tourniquet test, thrombocytopenia, and a haematocrit that is not yet haemoconcentrated) with no warning signs such as persistent vomiting, mucosal bleeding, abdominal pain, lethargy, or clinical fluid accumulation. This places her in WHO Group A dengue, for whom ambulatory care with oral rehydration, paracetamol for fever and pain, and daily clinical and platelet/haematocrit review is the recommended pathway, reserving admission for those who develop warning signs or evidence of plasma leakage. Aspirin and NSAIDs are avoided because of the bleeding risk from thrombocytopenia and platelet dysfunction. Isolated thrombocytopenia of 85 without bleeding does not itself mandate admission or transfusion; it is monitored serially as haematocrit trend, not platelet count alone, that best predicts progression to severe dengue. Why the other options are wrong: A, Admit for IV crystalloids: IV fluids and admission are indicated for warning signs or evidence of shock/plasma leakage, neither of which is present here; unnecessary admission overuses resources and does not alter outcome in Group A disease. C, Start oseltamivir empirically: this is an antiviral for influenza, which has no activity against dengue virus and is not indicated by this clinical picture. D, Administer platelet transfusion: prophylactic platelet transfusion for asymptomatic thrombocytopenia without active bleeding does not reduce bleeding risk or improve outcomes and is not recommended. E, Begin doxycycline for rickettsial infection: the illness fits the classic dengue tetrad with a positive tourniquet test, and empirical antibiotics are not appropriate for a viral haemorrhagic fever syndrome without features suggesting rickettsiosis (eschar, lymphadenopathy). Key point: Absence of warning signs in dengue (WHO Group A) means safe outpatient management with fluids, paracetamol, and daily review, not admission, transfusion, or antimicrobials.

Reference: WHO, Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control, 2009, Chapter on Case Classification and Management (Group A ambulatory care) - https://www.who.int/publications/i/item/9789241547871