Dengue fever is a common epidemic / endemic disease worldwide especially in under-developed countries and tropical areas. It has serious health, economical and epidemiological issues. If it's not managed properly, the mortality rate can be high. It's often confused with other acute infectious diseases such as chikungunya, malaria, typhoid and COVID. This diagnostic confusion is a big issue especially in resource limited countries where these are common, and sometimes these diseases can co-exist as well. These infectious diseases make a very difficult clinical puzzle that can mimic many other diseases as well and pose a great difficulty for the patient's management.As a result, many patients may be over treated for all these possibilities leading to antibiotic resistance, increased cost of treatment and prolonged illness. With proper management the mortality can be reduced. It's important to understand these diseases for managing patients with these infections, which almost every doctor see in clinical practice. This review article aims to provide insight into the pathogenesis of Dengue, its various manifestations, clinical approach for its differential diagnosis and its management considering recent evidence.