Hands tipping standing water out of a terracotta flower pot saucer into a drain on a sunny Malaysian porch with potted plants and an upturned pail

Demam Denggi (Dengue Fever): Tanda, Fasa Kritikal & Bila ke Hospital

Demam denggi (dengue fever) is a viral infection spread by the bite of Aedes mosquitoes, which bite during the day. Symptoms usually start 4 to 10 days after the bite and include a high fever, severe headache, pain behind the eyes, muscle and joint pain, nausea and a rash. Most people recover within 1 to 2 weeks with rest, fluids and paracetamol, but some develop severe dengue, often a few days into the illness as the fever goes down. Warning signs such as severe tummy pain, repeated vomiting, bleeding gums or nose, and fast breathing need hospital care immediately. Avoid ibuprofen and aspirin, which can increase bleeding. Dengue cases in Malaysia have shown a significant rising trend since 2000.

What is demam denggi?

Dengue is a viral infection spread to people through the bites of infected female mosquitoes, mainly Aedes aegypti. It is common in tropical and subtropical countries, mostly in towns and cities. According to the World Health Organization (WHO):

  • about half of the world's population is now at risk of dengue, with an estimated 100 to 400 million infections each year;
  • in 2024, a record of more than 14.6 million cases and over 12,000 deaths were reported worldwide;
  • most infections cause no symptoms or only mild illness, but dengue can occasionally become severe and even fatal.

In Malaysia, a study of dengue trends in Southeast Asia from 2000 to 2023 found a significant rising trend in dengue incidence, with a temporary dip during the COVID-19 pandemic followed by a resurgence.

You cannot catch dengue directly from another person. But a mosquito can pick up the virus by biting an infected person, from about 2 days before symptoms start until about 2 days after the fever ends, and then spread it to others. That is why preventing bites when you are ill also protects your family and neighbours.

Tanda demam denggi: what are the symptoms?

Symptoms usually begin 4 to 10 days after being bitten and last about 2 to 7 days. According to WHO and the NHS, they can include:

  • a high fever, which can reach 40°C;
  • a severe headache and pain behind the eyes;
  • muscle and joint pain (dengue is sometimes called "break-bone fever");
  • nausea and vomiting;
  • swollen glands;
  • a blotchy rash of flat or slightly raised spots that can cover large areas of the body.

Some of these symptoms are similar to flu. A severe headache with fever and pain behind the eyes is different from a typical migraine; see our guide to migrain and sakit kepala, and a cold usually comes with a runny nose and sore throat (see our guide to sakit tekak). In young children, fever with mouth ulcers and spots on the hands and feet is more likely to be HFMD. If you have a fever in Malaysia, see a doctor and mention that dengue is possible, especially if there are cases in your area.

After recovering, many people feel tired for several weeks.

Warning signs of severe dengue and the critical phase

A small number of people develop severe dengue. According to the NHS and WHO, this often happens a few days after the illness starts, as the temperature is returning to normal. This stage is often called the critical phase (fasa kritikal), and it is easy to mistake it for recovery.

Go to the emergency department immediately if you or someone with dengue has:

  • severe tummy (abdominal) pain;
  • vomiting again and again;
  • fast breathing;
  • bleeding gums or nose;
  • blood in vomit or stools;
  • extreme tiredness or restlessness;
  • being very thirsty;
  • pale and cold skin;
  • feeling weak.

People who are infected with dengue for a second time are at greater risk of severe dengue. Severe dengue needs hospital treatment, and early detection and good medical care greatly lower the risk of death.

How to care for dengue at home

There is no specific antiviral medicine for dengue. For mild dengue, WHO and the NHS recommend:

  • rest;
  • drink plenty of fluids, such as water or oral rehydration solution;
  • take paracetamol for fever and pain, following the dose on the pack;
  • do not take ibuprofen, aspirin or other anti-inflammatory painkillers, because they can increase the risk of bleeding;
  • watch for warning signs every day, especially as the fever goes down;
  • use a mosquito net or repellent while you are ill, so mosquitoes do not spread the virus to others.

Keep any follow-up appointments your doctor arranges, even if you feel better.

Tests, platelets and hospital care

A doctor may confirm dengue with a blood test, such as a rapid test or a laboratory test, which work best within the first week of illness. You may also have repeated blood counts to check your platelets and other levels, and to decide whether you need to be admitted. People with severe dengue need hospital care, mainly careful monitoring and fluids.

In Malaysia, doctors must notify dengue cases to the District Health Office within 24 hours of diagnosis under the Prevention and Control of Infectious Diseases Act 1988.

Does papaya leaf help dengue?

Papaya leaf juice and extracts are popular in Malaysia as a dengue remedy because they are said to raise platelet counts. A 2019 systematic review of nine studies, including one from Malaysia, found:

  • most studies reported higher platelet counts in people taking papaya leaf extract;
  • it may shorten hospital stay by about 2 days, but this was low-quality evidence;
  • there was no evidence that it prevents plasma leakage, serious complications or death.

The authors concluded that current evidence is not enough to recommend it. Papaya leaf should never replace medical care, fluids and watching for warning signs. If you want to take any herbal product, tell your doctor, and check that it is registered (see how to verify KKM registration).

How to prevent dengue

The mosquitoes that spread dengue bite during the day. WHO recommends protecting yourself from bites with:

  • clothes that cover as much of your body as possible;
  • mosquito repellents containing DEET, picaridin or IR3535;
  • window screens, and mosquito nets if sleeping during the day;
  • mosquito coils and vaporisers.

Stop mosquitoes breeding around your home. Aedes mosquitoes breed in containers that hold standing water. At least once a week:

  • empty and scrub flower pot trays, pet bowls, buckets and containers;
  • cover water storage containers;
  • clear blocked roof gutters and drains;
  • throw away rubbish that can collect rainwater, such as old tyres, cans and plastic containers.

Vaccine. WHO notes that one dengue vaccine (Qdenga) is licensed in some countries, and currently recommends it for children aged 6 to 16 in high-transmission settings. Ask your doctor whether a dengue vaccine is available and suitable for you in Malaysia.

Frequently asked questions (FAQ)

What are the symptoms of dengue (simptom denggi)?

Dengue symptoms usually start 4 to 10 days after an infected mosquito bite and can include a high fever, a severe headache, pain behind the eyes, muscle and joint pain, nausea or vomiting, swollen glands and a rash. Many people have mild or no symptoms, and most get better within 1 to 2 weeks.

What are the warning signs of severe dengue?

Warning signs include severe tummy pain, vomiting again and again, fast breathing, bleeding gums or nose, blood in vomit or stools, extreme tiredness or restlessness, being very thirsty, pale and cold skin, and feeling weak. They often appear a few days into the illness, as the fever goes down. Go to hospital immediately if you notice any of them.

Why is dengue dangerous when the fever goes down?

In some people, serious symptoms start a few days into the illness, just as the temperature returns to normal. This is often called the critical phase (fasa kritikal). It is easy to think you are getting better, so keep watching for warning signs and follow your doctor's advice on blood tests and check-ups.

What medicine can I take for dengue fever?

There is no specific medicine that cures dengue. Rest, drink plenty of fluids and take paracetamol for fever and pain. Do not take ibuprofen, aspirin or other anti-inflammatory painkillers, because they can increase the risk of bleeding.

Does papaya leaf juice help dengue?

Some small studies suggest papaya leaf extract may raise platelet counts, but a systematic review rated the evidence as low quality and found no evidence that it prevents severe dengue or deaths. It should never replace medical care, fluids and monitoring for warning signs.

Can you get dengue more than once?

Yes. You can be infected with dengue more than once, and according to the World Health Organization, people infected for a second time are at greater risk of severe dengue.

How can I prevent dengue?

Prevent mosquito bites during the day by covering up, using repellent containing DEET, picaridin or IR3535, and using window screens and nets. Stop Aedes mosquitoes breeding by emptying, cleaning or covering anything that holds water at least once a week, such as flower pot trays, containers, tyres and blocked gutters.

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.

References

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