The tourniquet test, which is particularly useful in settings where no laboratory investigations are readily available, involves the application of a blood pressure cuff at between the diastolic and systolic pressure for five minutes, followed by the counting of any petechial hemorrhages; a higher number makes a diagnosis of dengue more likely with the cut off being more than 10 to 20 per 1 inch2 (6.25 cm2).The diagnosis should be considered in anyone who develops a fever within two weeks of being in the tropics or subtropics. It can be difficult to distinguish dengue fever and chikungunya, a similar viral infection that shares many symptoms and occurs in similar parts of the world to dengue. Often, investigations are performed to exclude other conditions that cause similar symptoms, such as malaria, leptospirosis, viral hemorrhagic fever, typhoid fever, meningococcal disease, measles, and influenza. Zika fever also has similar symptoms as dengue.The earliest change detectable on laboratory investigations is a low white blood cell count, which may then be followed by low platelets and metabolic acidosis. A moderately elevated level of aminotransferase (AST and ALT) from the liver is commonly associated with low platelets and white blood cells. In severe disease, plasma leakage results in hemoconcentration (as indicated by a rising hematocrit) and hypoalbuminemia. Pleural effusions or ascites can be detected by physical examination when large, but the demonstration of fluid on ultrasound may assist in the early identification of dengue shock syndrome. The use of ultrasound is limited by lack of availability in many settings.
Finally, it may be possible to develop entry inhibitors, which stop the virus entering cells, or inhibitors of the 5′ capping process, which is required for viral replication.Carica papaya leaf extract has been studied and has been used for treatment and in hospitals. As of 2020, studies have shown positive benefits on clinical blood parameters, but a beneficial effect on disease outcome has yet to be studied, and papaya leaf extract is not considered a standard of practice therapy. References
External links

Dengue fever at Curlie

 This article was submitted to Open Medicine for external academic peer review in 2012 (reviewer reports). The updated content was reintegrated into the Wikipedia page under a CC-BY-SA-3.0 license (2014). The version of record as reviewed is: 
James Heilman; Jacob de Wolff; Graham Beards; Brian Basden;  et al. (2 October 2014). "Dengue fever: a Wikipedia clinical review". Open Medicine. 8 (4): e105-15. ISSN 1911-2092. PMC 4242787. PMID 25426178. Wikidata Q28651505.