J Md Noor N A Karim I Ismail R M Salehuddin



Dengue is a mosquito borne viral that are endemic in South East Asia and Pacific region. The incidence is increasing and so is the severity and mortality. According to WHO guidelines, severe dengue is characterized by severe plasma leakage, severe haemorrhage and severe organ impairment. Plasma leakage can be difficult to detect clinically in the initial stage. Myocardial depression, a sign of end organ impairment is also difficult to assess. Early detection of these signs can direct the patient to be placed under closer monitoring. It also results in a more judicious fluid therapy, which is the mainstay of dengue treatment.


We present five cases of dengue fever with ultrasound evidence of severe dengue. These patients have plasma leakages either in pleural or peritoneal cavity. One patient had myocardial depression. All five patients had gallbladder oedema with reticular pattern, a findings consistent with severe dengue, but not specified in the WHO guidelines. 3 of these patients were admitted to intensive care unit. All 5 patients survived.


Based on this, we suggest the ultrasound approach to identify some of the signs of severe dengue. Clinicians should look for effusions (pleural, peritoneal and pericardial), cardiomyopathy, gallbladder oedema, or E-C-G. Any positive findings will add value to the management of the patient in terms of monitoring and volume of fluid. Whether these findings have direct effect on mortality and morbidity requires a proper clinical study.


Supplementary Issue