The disease manifests as fever of sudden onset associated with headache, muscle and joint pains

(myalgias and arthralgias—severe pain that gives it the nickname break-bone fever or bonecrusher
disease), distinctive retro-orbital pain, and rash.[4]

The classic dengue rash is a generalised maculopapular rash with islands of sparing. A hemorrhagic rash
of characteristically bright red pinpoint spots, known as petechiae can occur later during the illness and is
associated withthrombocytopenia. It usually appears first on the lower limbs and the chest; in some
patients, it spreads to cover most of the body. There may also be severe retro-orbital pain, (a pain from
behind the eyes that is distinctive to Dengue infections), and gastritis with some combination of
associated abdominal pain, nausea, vomiting coffee-grounds-like congealed blood, or severe diarrhea.

Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral
infection when no rash or retro-orbital pain is present. Febrile travelers from tropical areas may transmit
dengue inadvertently to previously Dengue free populations of Aedes (Stegomyia) aegypti mosquitoes,
having not been properly diagnosed for Dengue. Patients only transmit Dengue when they are febrile and
bitten by Aedes (Stegomyia) aegypti mosquitoes, or (much more unusually) via blood products.

The classic dengue fever lasts about two to seven days, with a smaller peak of fever at the trailing end of
the disease (the so-called "biphasic pattern"). Recovery may be associated with prolonged fatigue and
depression.[5] Clinically, the platelet count will drop until after the patient's temperature is normal.

Cases of DHF also show higher fever, variable hemorrhagic phenomena including bleeding from the
eyes, nose, mouth, ear, into the gut, and oozing of blood from skin pores, thrombocytopenia,
and hemoconcentration. When Dengue infections proceed to DHF symptoms, DHF causes vascular leak
syndrome which includes fluid in the blood vessels leaking through the skin and into spaces around the
lungs and abdomen. This fluid loss and severe bleeding can cause blood pressure to fall; then Dengue
Shock Syndrome (DSS) sets in, which has a high mortality rate.

Neurological manifestations such as encephalitis may also occur