Afebrile dengue: An easily forgotten manifestation

How to cite this article:
Wiwanitkit S, Wiwanitkit V. Afebrile dengue: An easily forgotten manifestation. Ann Trop Med Public Health 2013;6:686


How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Afebrile dengue: An easily forgotten manifestation. Ann Trop Med Public Health [serial online] 2013 [cited 2021 Mar 4];6:686. Available from:

Dear Sir,

Dengue infection is an important tropical mosquito-borne infection. Many thousand dengue cases exist each year. Hence, dengue is still the global public health threaten. The classical clinical presentations of dengue include acute febrile illness with dengue triads, hemoconcentration, atypical lymphocytosis, and thrombocytopenia. [1] Nevertheless, atypical clinical features can be seen, and this is an actual difficulty in diagnosis. Here, the authors would like to share experience and concern on the important condition, a febrile illness. The authors analyzed the data on body temperature of 50 cases with diagnosis of dengue hemorrhagic fever (confirmed dropped platelet count, virological study) and found that there are up to 22 cases (44%) that had no fever on visiting. This is very important observation since it can lead to misdiagnosis. According to the previous report, fever was noted as the most common clinical presentation of dengue patients. [2] The afebrile dengue is an interesting condition that is rarely mentioned in the literature. In fact, Yoon et al. previously observed an interesting high rate of afebrile presentation of dengue in a previous outbreak in Thailand. [3] According to that report, up to 20% had afebrile presentation. [3] The exact pathobiology for the newly observed cluster of afebrile dengue is still unknown.



1. Wiwanitkit V. Bleeding and other presentations in Thai patients with dengue infection.ClinApplThrombHemost 2004;10:397-8.
2. Wiwanitkit V. Dengue fever: Diagnosis and treatment.Expert Rev Anti Infect Ther 2010;8:841-5.
3. Yoon IK, Rothman AL, Tannitisupawong D, Srikiatkhachorn A, Jarman RG, Aldstadt J, et al. Underrecognized mildly symptomatic viremic dengue virus infections in rural Thai schools and villages. J Infect Dis 2012;206:389-98.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.140273

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