Fever that will not go away is a source of anxiety in Guwahati every monsoon and post-monsoon season, because dengue, malaria, typhoid and ordinary viral fever look alike in the first few days. The right test depends on which day of illness you are on, and the most dangerous part of dengue often begins just as the fever seems to be easing. This guide explains which test to do when, how to read a falling platelet count, and which symptoms mean you should go to hospital without waiting. UHS Vista offers fever and infection screening, including dengue, malaria and Widal tests, in its in-house lab in South Sarania.
Dengue, Malaria, Typhoid or Viral Fever?
Early on, all four can cause fever, body ache, headache and weakness. Some pointers:
- Dengue usually brings sudden high fever, severe body and joint pain, pain behind the eyes, and sometimes a rash. Cough and runny nose are uncommon.
- Malaria is common in Assam. Fever may come with chills and rigors and sometimes follows a cycle, though many cases do not. It needs a blood smear or rapid antigen test.
- Typhoid tends to build gradually over days, with a step-ladder rise in fever, abdominal discomfort, and constipation or loose stools.
- Viral fever and influenza usually come with cold, sore throat and cough, and settle in three to five days.
Symptoms alone cannot separate them reliably, which is why a doctor will order a panel of tests. It is possible to have more than one infection at the same time.
Which Dengue Test and When
Dengue tests detect either the virus itself or your body's response to it, and each has a window:
- NS1 antigen detects a protein of the virus. It is most useful in the first five days of fever, when the virus is in the blood. A positive result is reliable. A negative NS1 after day five does not rule dengue out.
- Dengue IgM antibody begins to appear from about day four to five of illness and stays positive for a few weeks. It is the test for people who come later in the illness.
- Dengue IgG antibody shows past exposure. A high or rising IgG with a negative IgM can suggest a repeat infection, which can be more severe.
- PCR detects viral genetic material, and is mainly used in specific situations.
A common reason for confusion is a patient tested on day one or two with an antibody-only test, getting a negative result and being told it is not dengue. NS1 is the better early test. Tell the doctor or lab how many days of fever you have had, so the right test is chosen.
Reading the Platelet Count
Platelets help blood clot. A normal count is roughly 150,000 to 450,000 per microlitre. In dengue the count typically falls from about day three or four and reaches its lowest point around day five to seven, before recovering.
Three points are often misunderstood:
- The number alone does not tell you how sick you are. A count of 40,000 in someone who is well and drinking fluids can be safe to manage at home with monitoring. A count of 80,000 in someone with severe abdominal pain and vomiting is a reason to be admitted.
- Platelet transfusion is not given for a low number by itself. Current guidance reserves it for significant bleeding or very low counts, since transfusions in a stable patient do not improve outcomes. Your doctor decides.
- The haematocrit matters as much as platelets. A rising haematocrit (the concentration of red cells) together with falling platelets suggests plasma is leaking out of the blood vessels, which is the hallmark of severe dengue.
This is why doctors often repeat a complete blood count (CBC) every day or two during the critical days rather than testing once.
The Three Phases of Dengue
Febrile phase (days 1 to 3 or so): High fever, aches, flushed face. Many people feel they will recover soon.
Critical phase (around days 3 to 7, often as the fever drops): This is the dangerous window. Plasma can leak from the vessels, causing low blood pressure, fluid in the chest or abdomen, and bleeding. A drop in temperature does not mean recovery in this phase, and patients should be monitored closely.
Recovery phase: Fluid is reabsorbed, appetite returns, sometimes with an itchy rash on the limbs. Tiredness can last for weeks.
Warning Signs: Go to Hospital Without Waiting
Seek medical care immediately if a person with fever, or one who has just recovered from it, has:
- Severe or persistent abdominal pain
- Repeated vomiting or being unable to keep fluids down
- Bleeding from the gums or nose, blood in vomit, black stools, or heavy periods
- Cold, clammy skin, or extreme drowsiness or restlessness
- Breathlessness or very little urine
- A child who is unusually sleepy, cries inconsolably, or refuses all feeds
Care at Home When Dengue Is Confirmed and You Are Well
- Drink plenty of fluids: water, oral rehydration solution, coconut water, soups, and diluted fruit juice, in small and frequent amounts.
- Use paracetamol for fever and pain, following the dose your doctor gave. Avoid ibuprofen, diclofenac, aspirin and other anti-inflammatory painkillers, which can worsen bleeding risk and stomach irritation.
- Rest, and do not take part in strenuous activity during the recovery weeks.
- Get repeat blood counts as your doctor advises, and do not stop monitoring because the fever has gone.
- Do not take papaya leaf juice or other remedies as a replacement for monitoring. Small studies of their effect on platelet counts are limited, and none replaces medical follow-up.
Typhoid and Malaria Tests
Malaria: a peripheral blood smear or a rapid antigen test, ideally done during fever. Malaria is treatable, but delay in diagnosis is risky, especially for the falciparum type, so any fever with a travel or local exposure history should include a malaria test.
Typhoid: The Widal test is widely used but has limits. It can be falsely positive after past infection or vaccination, and falsely negative early in illness. Blood culture in the first week is more definitive, and your doctor may combine it with other tests. A positive Widal in isolation should be read alongside symptoms.
Preventing Dengue at Home
The Aedes mosquito breeds in clean standing water and bites mostly during the day. Empty and scrub water from coolers, flower pot trays, buckets, discarded tyres and roof tanks at least once a week, keep water containers covered, use mosquito nets or repellents, and wear long sleeves in the early morning and late afternoon. Cases cluster in households and neighbourhoods, so cleaning a shared area matters.
Frequently Asked Questions
My fever is on day 2 and the dengue antibody test is negative. Is it dengue?
It could still be. Antibodies take time to appear. NS1 antigen is the better test in the first five days, and a repeat test later can also help.
What platelet count is dangerous in dengue?
There is no single number. Doctors look at the trend, symptoms, haematocrit and bleeding. Counts below 20,000 or 10,000, or any bleeding, are watched very closely.
Can I get dengue twice?
Yes. There are four types of the virus. Infection gives lifelong protection against that type but only short-term protection against the others, and a second infection with a different type can be more severe.
How long does fatigue last after dengue?
Weakness and low energy can last two to four weeks, sometimes longer. Return to work and exercise gradually.
Child's fever has lasted three days. Should I test for dengue?
Fever lasting more than three days in a child deserves a doctor's visit. Our guide on a child's fever that will not go down after 3 days covers what to watch for.
Testing and Care at UHS Vista
Our in-house lab runs the CBC, NS1 and dengue antibody tests, malaria and Widal tests, with same-day reporting in most cases. Our paediatricians, including Dr. Sourabh Duwarah and Dr. Devajit Sharma, see children with fever, and our internal medicine specialists, including Dr. Amal Dev Goswami, assess adults and decide when monitoring or admission is needed. Book a fever panel or call +91 92879 88515. If you have any warning sign listed above, go to the nearest emergency department without delay.
Visit us: Dwarka Centre, Saniram Bora Road, behind Bora Service, South Sarania, Lachit Nagar, Guwahati, Assam
Timings: Monday to Saturday, 7:30 AM to 8 PM. Sunday, 7:30 AM to 1:30 PM.
Contact: +91 92879 88515 | uhsvista@gmail.com
