Every year, during the monsoon and even in the winter months, there is a deadly epidemic that threatens thousands of Nepalese across the country’s seventy-seven districts. Dengue fever, which has more than five thousand recorded cases to date in Nepal alone as of September 2026, is a deadly disease carried via mosquitoes that, despite most people recovering at home, can easily turn serious and even become life-threatening.
It is of utmost importance to know the signs and symptoms of dengue fever, well as the warning signs of severe dengue and the actions to take if they appear. This article aims to explain, in simple language, what symptoms and signs of dengue fever are, as well as what to do if one suspects having dengue or developing severe dengue.
What Is Dengue Fever and How Do You Get It?
Dengue fever is a viral infection transmitted from person to person through the bite of the Aedes mosquito. The Aedes mosquito, responsible for spreading dengue, usually bites humans during the early morning and afternoon hours. It lays eggs in stagnant water, which can include water containers, flower vases, old tires, and other water sources near one’s residence or area.
The Aedes mosquito becomes infected with the dengue virus when it bites a person with dengue fever. The virus then replicates inside the mosquito and can be transmitted to another person through a bite. Dengue outbreaks are more common in Nepal during the rainy season, as the Aedes mosquitoes are more active and numerous throughout the country. Nevertheless, dengue fever cases have been reported across Nepal, including the mountainous regions, during the winter months as well. Dengue fever is now considered an endemic disease in Nepal, as there have been numerous reported cases of it from seventy-four of the seventy-seven districts.
Common Dengue Symptoms and Signs
The symptoms of dengue fever appear four to ten days after being bitten by an infected mosquito. However, it is important to note that only about a quarter of infected people will display noticeable symptoms, and some may have very few or none at all. Dengue symptoms usually appear suddenly, and they could be severe.
The most common initial dengue symptom is high fever, which could reach up to 39-40 degrees Celsius. It is usually accompanied by a severe headache, particularly behind one’s eyes, as well as body and joint pains. The latter symptom is so common and severe that it is one of the defining symptoms of dengue fever — which is why the disease is sometimes referred to as breakbone fever. The fever usually lasts for two to seven days and then subsides. One may also experience nausea or vomiting, a lack of appetite, and general weakness. A rash is also a common symptom of dengue fever, which appears two to five days after the fever starts on the and spreads to other parts of the body. It may be accompanied by itching and peeling.
Some people with dengue fever may also experience minor bleeding, such as from the nose or gums, as well as easy bruising or petechiae, which are small red spots on the skin caused by bleeding underneath the skin. This is caused by the decrease in platelets in the blood, which is normal in dengue fever. However, if the platelet count is significantly low, it may lead to severe internal bleeding.
The Three Stages of Dengue – What Makes It Deadly
There are three stages of dengue fever: the febrile stage, the critical stage, and the recovery stage. Understanding these stages and their associated symptoms is essential in determining when to seek medical care and what to expect during each stage.
The febrile stage lasts two to seven days and is characterized by high fever, severe headache, eye pain behind the eyes, muscle and joint pain, nausea, vomiting, and sometimes rash. The symptoms during this stage are usually manageable at home with simple measures like staying hydrated, resting, and taking paracetamol to reduce fever.
The critical stage begins when the fever starts to subside, which is usually between three and seven days after the initial infection. This is the most dangerous stage of the disease, during which severe dengue can develop. Severe dengue is characterized by warning signs, and it is essential to get medical help as soon as possible since severe dengue requires hospitalization and special care. The critical stage lasts for about twenty-four to forty-eight hours and typically ends when the patient’s condition begins to improve. If the patient survives severe dengue, they enter the recovery stage.
The recovery stage lasts for two to three days. The patient’s appetite and urine output return to normal, and the rash starts to peel off. The platelet count also begins to return to normal during this stage. However, some patients may feel itchy all over, and they might require medication to soothe the itching. The fatigue may linger for a few weeks.
Warning Signs of Severe Dengue – When To Visit the Doctor?
The most important information for this section is that during the critical stage, it is necessary to seek medical attention right away. The critical stage begins when the fever starts to subside, which is around the third to seventh day after the infection. Many people incorrectly assume that they are recovering if their fever has gone away, when in reality, they have entered the most dangerous stage of the disease. The following are the warning signs of severe dengue:
Severe abdominal pain or tenderness is one of the most common warning signs of severe dengue. The pain is often intense and located in the upper abdomen. It can also be accompanied by persistent vomiting. If vomiting occurs three or more times within twenty-four hours, that is also a warning sign of severe dengue.
Bleeding is a severe warning sign for dengue fever, but it is not exclusive to dengue. If any form of bleeding occurs, including vomiting blood or material resembling blood, passing black-colored or tarry stools, bleeding from the nose or gums, or abnormal menstrual bleeding, it is a warning sign. Bleeding is a severe complication of dengue fever, so it is crucial to seek medical help whenever it develops. These symptoms are caused by decreased platelet levels in the blood, which makes the blood less able to clot.
Changes in mental state are also a warning sign of severe dengue. Specifically, the development of lethargy, restlessness, irritability, confusion, and difficulty awakening from sleep are all warning signs. In children, these symptoms may also present themselves as uncharacteristic crying. These mental changes are dangerous because they indicate that the blood is not getting enough oxygen, which can lead to organ failure.
Cold and clammy extremities, dizziness, fainting spells, or a feeling of impending loss of consciousness are also warning signs. They can indicate that the patient is going into shock due to severe dengue. Rapid breathing or difficulty breathing is another warning sign of severe dengue. It indicates that there may be fluid accumulation in the lungs or abdominal cavity. Finally, a decrease in urine output, or less frequent urination, is a warning sign due to decreased kidney function. In adults, decreased urine output is defined as urinating less frequently than once every four to six hours. In children, decreased urine output is more frequent since their kidneys are smaller.
When to Visit a Doctor For Dengue?
The short answer to this section is that a person should consult a physician as soon as they suspect that they have dengue fever, especially during the monsoon season or in case they are in an area with dengue cases. Consulting a doctor in the early stages of the disease ensures that the doctor can assess the severity of the situation while making the diagnosis, recommend the necessary tests, and prescribe the necessary medication. The doctor will also inform the patient what symptoms to look out for and when to return to the hospital.
A person should visit a doctor or hospital in the following circumstances:
Any of the warning signs of severe dengue described above begin to appear at any time.
It is essential to seek medical attention as soon as possible in case any of the warning signs appear rather than waiting for them to disappear. Moreover, severe dengue should always be treated in the hospital because severe dengue can lead to complications requiring specialized care. The Nepal national guidelines specifically state that patients with warning signs should be brought to the hospital immediately.
People with the following characteristics should also seek medical attention right away even with mild symptoms and warning signs as described:
Pregnant women, infants, and children, the elderly (over 60 years), and people with pre-existing conditions such as diabetes, hypertension, heart disease, renal problems, or obesity are more likely to be severely ill or have serious complications if they have dengue fever.
People should seek medical attention if they are unable to keep fluids down due to vomiting or severe weakness. In addition, a person unable to maintain their fluid intake because they cannot drink water or eat has a higher risk for severe dengue. This is especially true for people living in remote areas or with little or no family support.
What Happens at the Hospital for Dengue?
When arriving at the hospital, the medical staff will determine whether a dengue patient has warning signs and whether they have severe dengue. They will measure the patient’s blood pressure, pulse rate, respiratory rate, and temperature and examine them for any signs of bleeding, abdominal tenderness or distension, fluid retention, and organ enlargement. The doctors will also take blood tests to determine the platelet count, hematocrit levels, and general health. Based on the results of these tests, the doctors will determine whether the patient has warning signs, severe dengue, or neither.
Patients without warning signs who are otherwise healthy and have family support can be sent home with recommendations to drink plenty of fluids, take paracetamol for fever, and avoid NSAIDs, with advice to return to the hospital immediately if any warning signs appear. Patients with warning signs or severe dengue should be hospitalized, where doctors will give them fluids to prevent severe dehydration, monitor their condition, and perform additional tests. For patients with severe dengue, the doctor’s recommendations will depend on their symptoms and may include platelet transfusion in case of critically low platelet count, among other treatments. Most patients with warning signs and severe dengue will recover within a few days with appropriate treatment.
Patients with severe dengue, such as hemorrhagic dengue or dengue shock syndrome, should be hospitalized immediately and receive intensive care as soon as possible. Fortunately, the mortality rate from severe dengue is less than 1% with proper treatment at the hospital. Nevertheless, there are still high risks with severe dengue, as ten to twenty percent of patients without appropriate treatment may die from severe dengue.
Home Care for Denga – What To Do When You Are Sick?
A person with a confirmed diagnosis of dengue and without warning signs may be sent home with recommendations to care for themselves until further notice. Such patients must make sure to drink plenty of fluids to avoid complications. They can drink water, oral rehydration solutions, coconut water, fruit juice, and soup. They should consume at least two to three liters of fluids per day, and even more if they have a fever, vomiting, or diarrhea. The fluid intake is crucial, as it reduces the risk of complications.
The patient should take paracetamol to reduce the fever and body pain as prescribed by their doctor. They should not take other NSAIDs, such as ibuprofen, as they increase the risk of bleeding in patients with dengue fever. The patient should also rest and avoid any strenuous activities, as they may worsen their condition. They can sponge themselves with lukewarm water to reduce body temperature and relieve the discomfort from high fever.
The patient should monitor themselves for any warning signs as their fever begins to subside, as this is when severe dengue can develop. A key indicator is the urine output — if the patient is unable to urinate every four to six hours or if their urine is less frequent than usual, they should contact their doctor immediately. The patient should also watch for any signs of bleeding, such as nosebleeds, vomiting blood, or having black or tarry stools. They should also be aware of how they feel — if a person experiences worsening symptoms instead of improvement as their fever subsides, they should contact their doctor immediately. A patient may also ask their family to watch for signs of severe dengue for them, especially at night.
The patient should have their platelet count checked as recommended by their doctor. Platelet transfusion may be necessary in some cases, although it is unlikely if the patient has no warning signs of severe dengue. It is normal for the platelet count to temporarily drop during dengue fever — it usually reaches its lowest point on the fifth or seventh day after the onset of the illness.
Preventing Dengue – How To Protect Yourself and Your Family
Unfortunately, there are currently no specific treatments for dengue fever. As such, the best way to deal with the disease is to prevent it from occurring. The Aedes mosquito can only reproduce in stagnant water, so it is essential to eliminate any potential water sources in and around one’s residence. Moreover, it is essential to ensure that water stored in any water containers is not left outside, as it may attract the mosquitoes. Any water that is not used for drinking or cooking purposes should be disposed of or kept in a secure location inaccessible to the mosquitoes.
It is also crucial to ensure that the Aedes mosquitoes do not bite. To do this, one should wear long-sleeved shirts, long pants, and socks whenever going outside during the morning and evening hours when the mosquitoes are most active. One should also use insect repellents, mosquito nets, and air conditioning if possible. Moreover, one should avoid being outside during the peak hours for Aedes mosquitoes.
On a community level, it is also necessary to get rid of large water sources, such as old tire wrecks or trash, to remove potential breeding grounds for the Aedes mosquitoes. Since mosquitoes can travel several kilometers, it is essential to involve local authorities in fighting the dengue epidemic. Local authorities can organize clean-up drives and fumigation drives. However, it is a mistake to rely solely on local authorities, as large-scale initiatives require the effort of every individual.
Moreover, individuals should avoid exposing people with dengue fever to mosquitoes, as it can lead to additional cases. People with dengue fever should use mosquito nets to ensure that they do not get bitten, as it will reduce the risk of the disease spreading. Mosquitoes can carry the dengue virus for up to a week, which makes an infected person with dengue fever even more dangerous. A person recovering from dengue fever should also avoid going outside if possible.
Final Thought
To summarize, dengue fever affects thousands and thousands of Nepalese citizens every year, from the mountains to the valley. The majority of people with dengue fever recover at home, while others require hospitalization because of severe dengue. It is crucial to recognize the signs and symptoms of dengue fever and understand the warning signs of severe dengue as well as the steps to take if they appear. If one suspects that they have dengue fever and do not know what to do next, it is essential that they consult a doctor as soon as possible. A doctor can recommend the necessary tests, procedures, and treatments. Additionally, it is also essential to understand that the most dangerous time for a person with dengue fever is when their fever goes away, as it often means they have progressed to severe dengue.
Seeking prompt medical care is essential, as severe dengue can be fatal. However, with the right treatment at the hospital, severe dengue has a very good recovery outlook. Any hospital in Nepal, including the capital city of Kathmandu, is fully prepared to treat dengue fever patients of all severity levels.
If you are suffering from the symptoms of dengue fever or believe you may have dengue fever, you can ask verified doctors at Upachar Sewa about what to do next. Ask them if hospitalization is required or if you can monitor your condition at home. Moreover, if you are experiencing any of the warning signs described in this article, it is essential that you go directly to the hospital instead of contacting the doctors at Upachar Sewa first. Your health and the health of your loved ones are important, so it is always better to be safe than sorry.
