As the fever decreases, warning signs of a severe infection may appear, such as:Severe abdominal painPersistent vomitingUncontrolled bleeding from gums or noseBlack tarry stool or blood in urineLethargy or restlessnessDifficulty breathingPale, cold, or clammy skinLightheadednessA severe infection can lead to shock and organ failure.
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There are 4 distinct, but closely related, serotypes of the virus that cause dengue DEN-1, DEN-2, DEN-3 and DEN-4.
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For example, one patient may present with diarrhea and abdominal pain, while another patient experiences infertility or anemia.

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The bigger issue is usually the shock the patient and their family have after the diagnosis is made.