Chattogram doctors warn of dengue 'critical phase' as cases rise

A drop in fever does not always mean a dengue patient is out of danger, as the next 24 to 48 hours can be the most critical period for some patients, doctors in Chattogram have warned.

The warning comes as Chattogram recorded 2,241 dengue cases and six deaths this year through yesterday, according to the latest data from the Civil Surgeon's Office.

At Chattogram Medical College Hospital (CMCH), 78 dengue patients were admitted as of yesterday. Doctors said around 10 to 15 were in critical condition, while many were arriving with shock and bleeding.

Professor Dr Anirudha Ghosh Joy, a medicine specialist at Chattogram Medical College, told TBS that it was difficult to predict which patients would suddenly deteriorate.

"We cannot say in advance when a dengue patient will move into a critical condition. Keeping the patient under observation is therefore the most important thing," he said.

Danger can begin when fever falls

Dengue generally progresses through three phases—febrile, critical, and recovery.

For some patients, the critical phase begins as the fever subsides and usually lasts 24 to 48 hours. During this period, fluid can leak from blood vessels, causing blood pressure to fall.

In severe cases, patients may develop shock, bleeding, breathing difficulties, or complications involving organs such as the liver, kidneys, and heart.

Anirudha said patients should not assume they have recovered simply because fever, body ache, or vomiting has eased.

"Many think the patient has recovered once these symptoms disappear. But the period after the fever can be critical. Patients should remain under monitoring for at least three days," he said.

Doctors advised seeking medical attention if patients develop severe abdominal pain, repeated vomiting, bleeding from the nose or gums, blood in vomit or stool, rapid breathing, unusual weakness or restlessness, reduced urine output, or falling blood pressure.

Anirudha said platelet levels could also begin to fall towards the end of the fever period and should be monitored alongside the patient's overall condition and other warning signs.

The Directorate General of Health Services' National Guideline for Clinical Management of Dengue, 5th Edition, 2025, says a platelet count below 100,000/mm³ can be an early indicator that a patient is entering the critical phase, when plasma leakage may occur. A rapid fall in platelets should also be assessed alongside rising hematocrit, reduced urine output, and other clinical signs.

Some dengue patients in Chattogram are also presenting without severe fever or other commonly recognised symptoms, doctors said.

Some report only mild fever, body ache, or weakness, while others mainly experience vomiting, abdominal pain, or loss of appetite.

Doctors said some patients initially mistake these symptoms for ordinary fever, gastric problems or general weakness and delay testing until complications develop.

Shock, bleeding cases rising at CMCH

Doctors at CMCH said the growing number of patients arriving with severe complications had become a major concern.

Dr Noor Mohammed, focal physician of the dengue ward at the hospital's medicine department, said many patients were arriving with shock syndrome and bleeding.

"Most are coming with shock. This year, we are seeing patients whose blood pressure cannot even be recorded. Many are also coming with bleeding, while some have both shock and bleeding," he said.

The hospital's specialised dengue ward has 40 designated beds, while 78 dengue patients were admitted to CMCH as of yesterday, according to the latest Civil Surgeon Office data.

"The problem is not doctors at the moment. We are able to provide services. But as the number of patients rises, the facilities also have to increase. That is the main problem," Noor Mohammed said.

He said additional beds, nursing support and other treatment facilities would be needed if patient numbers continued to rise.

August alone saw 1,202 cases

Dengue infections accelerated sharply in Chattogram from July.

The district recorded 298 cases during the first six months of the year. Cases then rose to 536 in July and 1,202 in August.

A total of 1,738 cases were recorded in July and August, nearly six times the number reported during the first six months of the year.

Another 205 cases were recorded in the first three days of September, including 55 in the 24 hours to yesterday.

Six people have died from dengue this year – one in February, two in July, two in August and one in September.

Sitakunda records highest upazila cases

Dengue has spread across upazilas as well as the city.

Sitakunda recorded the highest number of cases among the upazilas, with 279 patients through yesterday. Sandwip had the lowest, with 12 cases.

Shajedur Rahman said additional attention was being given to areas reporting higher numbers of patients, including Sitakunda.

Upazila health complexes were being kept prepared for diagnosis and treatment, while health education activities were also being strengthened, he said.

September remains a concern

Health officials fear infections could continue to rise in September if rainfall, temperature and humidity remain favourable for Aedes breeding.

Shajedur Rahman said eliminating Aedes breeding grounds remained the most important measure for preventing dengue.

People should not allow water to accumulate in yards, rooftops, containers, old tyres or discarded materials, he said.