Dengue symptoms: the early signs, the warning signs that can't wait, and safe care at home

High fever, a pounding headache, aching eyes and bones? Here's how dengue usually goes, the danger window after the fever drops, and what's safe to take.

Updated · Sources

Quick answer

What are the symptoms of dengue?

Dengue usually starts 4 to 10 days after the mosquito bite with a sudden high fever, a severe headache, pain behind the eyes, muscle, joint and bone pain, nausea or vomiting, and sometimes a rash. Symptoms last 2 to 7 days. Watch closely as the fever goes: severe tummy pain, repeated vomiting or bleeding then need emergency care.

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Health information, not medical advice. Your doctor knows your full picture; ask them about your result.

Side by side

Dengue vs malaria: how two mosquito fevers differ

Both start with fever after a mosquito bite and are common in the same parts of the world, but they're caught, treated and tested differently. These are the usual differences.

What you noticeDengueMalaria
The mosquitoAedes, which bites mainly during the dayAnopheles
When symptoms startUsually 4 to 10 days after the biteUsually 10 to 15 days after the bite
The feverSudden and high, lasting 2 to 7 daysFever with chills and headache; early signs can be mild
Typical painsSevere headache, pain behind the eyes, muscle, joint and bone painHeadache and tiredness
When it gets dangerousOften as the fever goes, usually in the 24 to 48 hours after it endsCan become severe within 24 hours without treatment
Danger signsSevere tummy pain, repeated vomiting, bleeding gums or nose, blood in vomit or poo, restlessnessConfusion or drowsiness, fits, difficulty breathing, dark or bloody pee, yellow skin, unusual bleeding
MedicineNo specific medicine; paracetamol for fever, never ibuprofen or aspirinAlways needs antimalarial medicine, started early
The testNS1 antigen or PCR in the first 7 days, IgM antibodies after day 3, plus a platelet countA rapid test or a blood film under a microscope

Typhoid, chikungunya, COVID-19 and other infections can also cause a high fever. Where dengue or malaria is common, any fever is worth a blood test, sometimes for both.

Dengue symptom checklist

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Dengue symptom checklist

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This checklist sorts symptoms into a pattern for your doctor. It can't diagnose dengue: only a blood test confirms it, and other infections, including malaria, can cause the same symptoms.

What is dengue, and how do you get it?

Dengue is a viral infection spread by the bite of infected Aedes mosquitoes, which bite mainly during the day. It doesn't spread directly from person to person.

It's common in tropical and subtropical countries: about half of the world's population now lives at risk, with an estimated 100 to 400 million infections a year.

Most infections are mild or cause no symptoms at all. About 1 in 4 people infected get sick, and about 1 in 20 of those who get sick develop severe dengue, which can cause shock, internal bleeding and death.

There are four types of dengue virus. Having one type doesn't protect you from the others, and a second infection carries a higher risk of severe dengue.

What are the symptoms of dengue, day by day?

Symptoms usually start 4 to 10 days after the bite, often suddenly:

  • a high fever, around 40°C (104°F)
  • a severe headache and pain behind the eyes
  • muscle, joint and bone pain (why it's sometimes called "breakbone fever")
  • feeling sick or vomiting
  • swollen glands
  • a blotchy rash
WhenWhat usually happens
4 to 10 days after the biteSymptoms begin, often suddenly
Fever phase, 2 to 7 daysHigh fever, headache, pain behind the eyes, body aches, nausea, rash
24 to 48 hours after the fever goesThe time when warning signs usually appear, if they're going to
Recovery, about 1 to 2 weeksMost people get better; tiredness can last a while

Feeling better as the fever falls doesn't mean it's over. Severe dengue often comes after the fever has gone, so keep watching for the warning signs below for the next 2 days.

What are the warning signs of severe dengue?

Go to a clinic or emergency department immediately if someone with dengue has:

  • severe tummy pain, or a tummy that hurts to touch
  • vomiting at least 3 times in 24 hours, or vomiting that won't stop
  • bleeding from the nose or gums
  • blood in vomit or poo
  • extreme tiredness, restlessness or irritability
  • fast breathing, or being very thirsty
  • pale, cold skin, or feeling very weak

These signs usually begin in the 24 to 48 hours after the fever has gone, and severe dengue can get worse within a few hours. Severe dengue is a medical emergency, but treated early in hospital, most people recover.

Higher risk: people who have had dengue before, because a second infection is more likely to be severe.

Which tests confirm dengue, and what about platelets?

A blood test is the only way to confirm dengue. Which test depends on the day of illness:

  • Days 0 to 7: an NS1 antigen test or a PCR test finds the virus, usually together with an IgM antibody test.
  • After day 3: IgM antibody tests pick up most recent infections; after day 7, they're the main test. IgM can stay positive for about 3 months.
  • A negative NS1 or PCR doesn't rule dengue out, so doctors go by symptoms too.

Platelets. A complete blood count (CBC) is checked, often repeatedly. Platelet counts often fall in dengue, and a falling platelet count together with a rising haematocrit (the share of the blood made up of red cells) is one of the changes doctors watch for. They decide treatment from the whole picture, including how the person is doing, not from the platelet number alone.

Doctors may also test for malaria or other infections when the cause of a fever isn't clear.

How is dengue treated, and what should you avoid?

There's no specific medicine for dengue. Most people get better at home with:

  • rest as much as possible
  • plenty of fluids: water, or drinks with added salts and sugar (oral rehydration solution)
  • paracetamol (called acetaminophen in the US) for fever and pain

Don't take ibuprofen, aspirin or other anti-inflammatory painkillers. They can increase the risk of bleeding in dengue. Check cold and flu remedies too, as some contain them. For the right amount of paracetamol, follow the pack or ask a pharmacist, and ask a doctor for a child.

Stop mosquitoes biting you during the first week. The virus is in your blood then, and a mosquito that bites you can pass it to others.

Severe dengue is treated in hospital, mainly with careful fluids and close monitoring. No home remedy, including papaya leaf, has been proven to treat dengue: ask a doctor before trying one, and never let it delay care.

How can you prevent dengue?

  • Avoid bites, especially during the day: wear long sleeves and trousers, use window screens, and sleep under a mosquito net if you sleep during the day.
  • Use an insect repellent containing DEET, picaridin or IR3535, as directed on the label.
  • Get rid of standing water where mosquitoes breed: cover, empty and clean water containers, buckets, plant pots and coolers once a week.
  • Vaccine: one dengue vaccine is licensed in some countries. WHO recommends it only for children aged 6 to 16 in places where dengue spreads a lot; some countries also offer it to travellers who've had dengue before. Ask your doctor whether it applies to you.

When to see a doctor

Book an appointment

  • A fever while living in, or after travelling to, a place where dengue is common: see a doctor the same day or the next, and ask for a dengue test and a platelet count.
  • Diagnosed with dengue and recovering at home: go back for checks and blood counts as often as your doctor advises.
  • As the fever goes: keep watching closely for warning signs for the next 24 to 48 hours, and go straight back if any appear.
  • You've had dengue before and are planning travel to a dengue area: ask a doctor about the vaccine before you go.

Get emergency help now (call your local emergency number) if someone has:

  • severe tummy pain, or vomiting at least 3 times in 24 hours
  • bleeding from the nose or gums, or blood in vomit or poo
  • extreme tiredness, restlessness or irritability, or fast breathing
  • pale, cold or clammy skin, fainting, or feeling very weak

Most people with dengue get better at home in 1 to 2 weeks. These signs can appear as the fever goes and get worse within hours: don't wait for them to pass, and don't drive yourself.

A fever and body aches in dengue season? Talk it through.

Saluvo listens to your symptoms in your own words and language, checks for warning signs first, and tells you which doctor to see and how soon. Already have a blood count or dengue test? It explains every value, platelets included.

Ask about my symptoms

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Questions people ask

  • Usually a sudden high fever, around 40°C (104°F), 4 to 10 days after the mosquito bite, with a severe headache, pain behind the eyes, and muscle, joint and bone pain. Nausea, vomiting, swollen glands and a rash are also common. Many infections cause mild symptoms or none at all.

  • The fever usually lasts 2 to 7 days, and most people get better in 1 to 2 weeks. The most important time is as the fever goes: warning signs of severe dengue usually appear in the 24 to 48 hours after it ends. Tiredness can last for some weeks after recovery.

  • Severe tummy pain, vomiting at least 3 times in 24 hours, bleeding from the nose or gums, blood in vomit or poo, extreme tiredness or restlessness, fast breathing, great thirst, and pale, cold skin or feeling very weak. Any of these means going to a clinic or emergency department immediately, even if the fever has gone.

  • Paracetamol (acetaminophen) for fever and pain, with rest and plenty of fluids. Don't take ibuprofen, aspirin or other anti-inflammatory painkillers: they can increase the risk of bleeding. There's no specific medicine for dengue itself. For the right amount, follow the pack or ask a pharmacist, and ask a doctor for a child.

  • There's no single number that decides on its own. Normal platelets are roughly 150,000 to 450,000 per microlitre, and they often fall in dengue. Doctors watch the trend, the haematocrit and how the person is doing, not the platelet number alone. Very low counts, or any bleeding, need hospital care; your doctor will tell you what your count means.

  • In the first 7 days of illness, an NS1 antigen or PCR test finds the virus, often with an IgM antibody test. After day 3, IgM tests pick up most recent infections, and after day 7 they're the main test. A negative NS1 doesn't rule dengue out. A complete blood count checks platelets.

  • Yes. There are four types of dengue virus, and having one type doesn't protect you from the others. A second infection carries a higher risk of severe dengue. If you've had dengue before, take extra care to avoid bites, see a doctor early with any fever, and ask about the vaccine before travelling to a dengue area.

  • Not directly: you can't catch it from another person by touch, coughs or sharing food. It spreads through mosquitoes. During the first week of illness the virus is in the blood, and a mosquito that bites then can pass it on, so the sick person should avoid bites, for example by sleeping under a net.

  • Drink plenty of fluids: water, or drinks with added salts and sugar, such as oral rehydration solution. Eat light, simple food when you feel able to. Being very thirsty, peeing much less, or being unable to keep fluids down because of vomiting are reasons to see a doctor straight away.

  • No home remedy, including papaya leaf juice, has been proven to treat dengue or to make it safer. The proven care is rest, plenty of fluids, paracetamol for fever, and watching closely for warning signs. Ask a doctor before trying a remedy, and never let it delay going to hospital when warning signs appear.

  • Most people get better in 1 to 2 weeks, although tiredness and low mood can last for some weeks after. Rest, eat well and build up activity slowly. See your doctor if you aren't improving, or if new symptoms appear.

  • One dengue vaccine is licensed in some countries. WHO recommends it only for children aged 6 to 16 in places where dengue spreads a lot, and some countries also offer it to travellers who've had dengue before. Ask your doctor whether it's right for you. Avoiding mosquito bites remains the main protection.

  • Symptoms overlap, so a blood test is the only reliable way. Dengue often brings pain behind the eyes, body and bone pain and a rash, starting 4 to 10 days after the bite. Malaria often brings fever with chills, starting 10 to 15 days after the bite, and always needs antimalarial medicine. Doctors may test for both.

Tests that help

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Sources

  1. WHO fact sheet: Dengue and severe dengue
  2. CDC: Symptoms of dengue and testing
  3. CDC: Manage dengue
  4. CDC: Clinical testing guidance for dengue
  5. NHS: Dengue
  6. WHO fact sheet: Malaria

Updated . Health information, not medical advice. Your doctor knows your full picture; ask them about your result.