According to a study published in the Journal of The Association of Physicians of India, a 50-year-old man was diagnosed with dengue even though he did not have a fever. Such rare cases can occur in patients who are likely to be old, diabetic, or suffering from other immunity-compromised states.
Hence, patients who do not have a fever are asked to look for crucial symptoms, such as restlessness, vomiting, body ache and severe weakness.
The case presented in the study was that of a nursing orderly working at AIIMS Hospital in Delhi. The patient complained of fatigue which led the doctors at the hospital to conduct a blood test.
The reports revealed that the patient had uncontrolled sugar and high levels of acid in the blood. The patient’s red blood cell, white cells and platelets were also very low, prompting the doctors to test him for dengue.
The patient also underwent an NS1 antigen test (nonstructural protein 1), a test for dengue, whose result showed positive for the mosquito-borne virus infection. The study added that the result was re-confirmed with a reverse transcription polymerase chain reaction (RT-PCR) test for the deadly disease.
The journal mentioned that although, majority of patients with dengue are asymptomatic, fever is the commonest presentation in symptomatic patients. It typically presents with an acute onset high grade fever, myalgia and retro-orbital pain.
However, the febrile response may be masked in certain conditions like diabetes, old age and other immunecompromised states.
Here, the doctors were presenting a case of afebrile dengue with severe manifestations in a diabetic patient with uncontrolled sugars.
My Medical Mantra, Dr Madhukar Gaikwad, Medical Superintendent of St George hospital said, “It is possible that a patient can be affected with dengue without having fever. This is because in any disease there can be a variation presentation of the symptoms.”
Dr Jayesh Lele, a general physician, said, “It is rarely witnessed that a patient is diagnosed with dengue without having fever. But one cannot deny the fact that the patient may have had a fever a few days back. Therefore, it is necessary to review the medical history of such a patient.”