Integrating structured point-of-care ultrasound into dengue fever management: A mini review and comprehensive clinical guide

Abstract

Dengue fever is one of the most common mosquito-borne viral diseases and poses a significant health threat. The primary management involves hydration tailored to the disease stage and severity. Although many cases are mild, dengue can rapidly progress within hours. Complications such as plasma leakage and bleeding are difficult to detect through routine clinical assessment alone. In this context, point-of-care ultrasound (POCUS) has emerged as a valuable bedside tool for the early detection of fluid shifts and plasma leakage. Ultrasound findings in dengue-related plasma leakage include gallbladder wall thickening, ascites, pleural effusions, and other third-space fluid shifts. These sonographic signs often precede the clinical presentation of plasma leakage and can serve as early indicators for impending shock. Regular ultrasound assessment facilitates risk stratification and timely intervention, potentially reducing progression to dengue shock syndrome. Currently, there is no validated POCUS protocol specific to dengue assessment. We propose a standardized, structured ultrasound protocol focusing on key diagnostic parameters, coupled with serial serum hematocrit and lactate measurements for a comprehensive evaluation. This approach facilitates earlier identification of at-risk patients, thereby improving patient management, preventing clinical deterioration, and reducing morbidity and mortality associated with severe dengue.

Keywords: Dengue fever; Plasma leakage; Point-of-care ultrasound (POCUS); Pulmonary interstitial edema; Ascites; Pleural effusion; Pericardial effusion; Gallbladder wall thickening

Core Tip: This standardized, structured ultrasound protocol focuses on key diagnostic parameters, including gallbladder wall thickness; the presence and extent of ascites, pleural effusion and pericardial effusion; pulmonary interstitial edema; and assessment of fluid responsiveness/tolerance. When integrated with serial serum lactate measurements, it provides a comprehensive framework for clinical evaluation. This approach aims to enable earlier identification of at-risk patients across both general ward and intensive care settings, thereby improving patient care in dengue and reducing morbidity and mortality.