What is the Dengue Triad?

Classified as DENV-1, DENV-2, DENV-3, and DENV-4, there are four types of viruses belonging to one group (Flaviviridae) that are responsible for infecting humans with dengue fever. The route for transmitting the virus from one infected human to another is via the bloodsucking bite of the female Aedes Aegypti mosquito.

There are three core symptoms that are rarely missing in a dengue infection – fever, pain, and skin rash – and for this simple reason, the patient is considered to be under the influence of the 'dengue triad' of symptoms.  

The "Dengue Triad"

1. The Fever of a Typical Dengue Infection

It takes three elements to spread dengue – the infected human that is bitten by Aedes, the Aedes mosquito (blood sucking female) that acts as the carrier for the virus, and the healthy human that receives the virus via the mosquito bite. The virus takes around five days to incubate in the body. By the fifth or sixth day, the circulatory system would be filled to capacity with a large number of viruses.

The dengue triad of symptoms begins to appear from the sixth day onwards. By the time fever strikes, it can be assumed that the virus has incubated and spread in the body for a minimum of five days.

The fever (39°C/102°F) usually takes its toll over six to seven days, bringing the total infection period to two weeks. Occasionally, the fever subsides by the third day, and the patient is free to resume a normal life. The danger is the pea of the second fever that may follow in extreme scenarios. Reaching that peak is generally very bad news and a portent of the more dangerous Dengue Hemorrhagic Fever.

• The Dengue Hemorrhagic Fever (DHF)

Dengue that remains untreated, or which happens to be mistakenly diagnosed and wrongly treated as some other fever, can assume a more virulent form. In DHF, raging fever (40°C/104°F) continues as the body gets wracked by pain and intense bleeding. Without speedy emergency medical assistance, the mortality rate among such patients will be high.

2. The Pain of a Typical Dengue Infection

Pain is an overwhelming sensation in dengue fever. It affects almost every part of the body, making even the slightest movement excruciating and labored. It is for this reason that dengue is also referred to as “breakbone fever.”

• The head and eyes

The headaches are a constant companion in dengue fever, and a dull aching sensation pressures the eyeballs from behind.

• The joints, muscles, and bones

An almost arthritic pain envelops the joints making movements painful. Muscles stiffen and get cramped, and bones become agonizingly tender even on minor impact.   

• The abdomen

This pain is the most dangerous of them all as it may signal major problems in the gastrointestinal tract, maybe even loss of blood, which is lost via vomiting.

3. The Skin Rash

In the majority of dengue patients, rashes begin to break out on the skin within days of onset of characteristic symptoms. By the fifth or sixth day of infection, the rashes become measles-like. They appear in the lower limbs and on the chest forming large swathes of red with grayish white centers. Simultaneously, small spots or petechiae appear, which represent tiny bursting capillaries that hemorrhage into surrounding tissues. As this happens just under the outer skin they become visible as blood red spots.

In DHF, the outer mucosal linings of the nasal passages and mouth including the gums start bleeding as blood vessels swell and leak their contents.