>The DAN medic to whom she spoke suggested that she seek medical attention at the closest emergency department. While the possibility of decompression injury could not be excluded, the timing and the nature of her symptoms made other possible explanations more likely. When she arrived at the emergency department she had a fever of 103°F. She underwent a variety of diagnostic procedures, including several laboratory tests and thorough physical and neurological examinations. All indications pointed to a diagnosis of dengue fever, not DCS.
>The hospital staff administered appropriate supportive care, which included IV fluids and medications to help manage her pain and nausea. She was ultimately discharged, and the doctor instructed her family on how to monitor her condition and continue her care. The fever and nausea subsided within three days, and the aches and headache finally resolved after two weeks.
>The importance of receiving a medical assessment that considers multiple possible diagnoses cannot be overstated. While localized pain and severe fatigue are common symptoms of DCS, generalized muscle pains and fever are not. The evaluating physician recognized this and expanded the differential diagnosis list accordingly. The diagnosis of dengue fever is made on the basis of clinical findings (signs and symptoms) as well as history of travel to known risk areas. Fortunately, this tropical disease is not generally life-threatening, and full recovery is expected within a few weeks, as occurred in this case.
>Most divers are familiar with the signs and symptoms of DCS, but it is important to remember that these signs and symptoms are not exclusive to DCS and may indicate other maladies.
>• Acute fever
>• Muscle and joint aches/pain
>• Severe frontal headache
>• Acute pain behind the eyes
>• Nausea and loss of appetite
>• Rash
>• In rare cases, bleeding
>The pain associated with the disease can be severe, especially in subsequent infections. This severe pain gave rise to dengue's nickname, "breakbone fever." Medical care for infected people is aimed at symptom reduction, as there is no cure (nor is there a vaccine). The fever and pain should be managed with acetaminophen (Tylenol); avoid aspirin, ibuprofen, naproxen and other nonsteroidal anti-inflammatory drugs (NSAIDs) as these can promote bleeding.
>In most cases the fever resolves within a few days, but fatigue may persist for days to weeks. To learn more about dengue and other tropical diseases, visit the website of the Centers for Disease Control and Prevention (www.cdc.gov) or the World Health Organization (www.who.int). As always, if you develop symptoms after diving, do not hesitate to contact DAN.
>© Alert Diver — Summer 2013