dengue fever

Compatible dengue syndrome

Preserve reported and observed fever, pain, rash and other manifestations with onset times and observer provenance.

1. Which manifestations support considering dengue, when did they begin, and which were reported rather than directly observed? measurement
2. Which findings require assessment for malaria, chikungunya, Zika, bacterial infection or a concurrent illness? boundary

Exposure and history evidence

Separate documented travel, residence and prior infection from assumptions about exposure or immunity.

1. Where was the person before symptom onset, on which dates, and what dated evidence supports dengue transmission there? provenance
2. What evidence exists for prior dengue, a known previous serotype, or flavivirus vaccination, and what remains unknown? provenance

Time-qualified test result

Record NAAT, NS1 and antibody results with specimen details; acute-phase testing and later serology have different roles. [CDC testing guidance](https://www.cdc.gov/dengue/hcp/diagnosis-testing/index.html)

1. Which assay and specimen produced each result, and how long after symptom onset was the specimen collected? measurement
2. Does the applicable testing guidance call for an additional or convalescent specimen given the timing and existing results? action

Confirmation and residual ambiguity

Retain conflicting evidence and serological cross-reactivity; a single IgG result is not recommended for diagnosing acute dengue. [CDC testing guidance](https://www.cdc.gov/dengue/hcp/diagnosis-testing/index.html)

1. Which named criteria support the recorded diagnostic category, and who made that interpretation? definition
2. Could prior infection, vaccination, another flavivirus or discordant testing explain the result, and what would resolve the ambiguity? boundary

Phase assignment

Record the evidence for febrile, critical or recovery phase, including uncertainty when onset or fever resolution is unclear.

1. What are the best-supported symptom-onset and defervescence times, and how uncertain are they? measurement
2. What observations justify the current phase, and when must that assignment be reassessed? definition

Trajectory in treatment context

Align haematocrit, platelets, perfusion, urine output and fluid administration so isolated measurements do not dominate interpretation.

1. How have haematocrit, platelets, circulation and urine output changed across comparable observation times? measurement
2. Could fluid administration, bleeding, baseline variation or measurement quality account for the apparent change? boundary

Warning-sign presence

Assess abdominal pain or tenderness, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy or restlessness, liver enlargement and rising haematocrit with rapidly falling platelets. [WHO outbreak toolbox](https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/dengue-outbreak-toolbox)

1. Which warning signs are present, absent, uncertain or unassessed, and when was each last checked? measurement
2. What urgent clinical review or escalation does the current warning-sign pattern require under the applicable protocol? action

Severity mechanism and attribution

Record leakage-related shock or respiratory distress, severe bleeding and severe organ impairment separately, including alternative explanations.

1. What evidence establishes each severe manifestation, and which severity definition is being applied? definition
2. Which findings demand emergency escalation, and which may also reflect sepsis, another disease or a treatment complication? action

Disposition rationale

Capture the clinician's disposition decision with pregnancy, age, comorbidities, oral intake, available support and access to care as applicable.

1. Which host factors and follow-up barriers change the monitoring or admission decision for this episode? measurement
2. Who selected the care setting, which protocol supports it, and what changes trigger transfer or admission? action

Fluids, medications and reassessment

Record clinician-directed hydration and symptom treatment; aspirin and ibuprofen can increase bleeding risk in dengue. [WHO dengue guidance](https://www.who.int/news-room/questions-and-answers/item/dengue-and-severe-dengue)

1. What fluids and medicines were ordered and administered, and what subsequent observations document benefit or harm? measurement
2. Which medication exposures, persistent perfusion problems or signs of fluid overload require clinician review of the plan? action

Supported episode outcome

Link the outcome to clinical assessment, remaining symptoms and responsibility for unresolved findings.

1. What evidence and applicable discharge criteria support recovery or closure, and which symptoms or abnormalities persist? boundary
2. Who owns follow-up of pending tests, persistent symptoms or organ injury, and when is reassessment due? action

Prevention and reporting handoff

Record advice to reduce mosquito bites during illness and link authorised case notification to the relevant public-health process. People with dengue can infect mosquitoes that bite them. [WHO dengue guidance](https://www.who.int/news-room/questions-and-answers/item/dengue-and-severe-dengue)

1. What mosquito-bite prevention advice was provided, for what period, and can the person follow it? action
2. Which jurisdictional case definition and notification requirements apply, and what reporting has been authorised and completed? provenance

Kinds and varieties

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these kinds and varieties hold for the sense of dengue fever this model covers, and on what evidence? provenance

Identifiers and schemes

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these identifiers and schemes hold for the sense of dengue fever this model covers, and on what evidence? provenance

Standards and regulation

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these standards and regulation hold for the sense of dengue fever this model covers, and on what evidence? provenance

Real-world use

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these real-world use hold for the sense of dengue fever this model covers, and on what evidence? provenance

Typical measurements

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these typical measurements hold for the sense of dengue fever this model covers, and on what evidence? provenance

Failure modes and hazards

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these failure modes and hazards hold for the sense of dengue fever this model covers, and on what evidence? provenance

Regional variation

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these regional variation hold for the sense of dengue fever this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Reported by the breadth pass; each item needs checking against its source before it becomes normative.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of dengue fever this model covers, and on what evidence? provenance