Background: In dengue-endemic countries such as Bangladesh, early discrimination of dengue from other acute febrile illnesses (AFI) in outpatient practice is a pivotal practical strategy to expedite proper case management and optimize resource utilization, but the predictive value of common symptoms like myalgia and chills are poorly quantified. The prevalence, diagnostic accuracy and independent predictors for laboratory confirmed dengue among adults’ outpatients in Dhaka, Bangladesh were the objectives of this study. Methods: A hospital-based cross-sectional study was carried out in two tertiary hospitals, Dhaka during the period from January to December 2025. The consecutive AFI (History & examination duration ≤7 days) adults older than 18 years were included. Symptoms were assessed using a structured questionnaire and included information on myalgia (presence and severity, from 1 to 10), and chills. NS1 antigen and/or IgM antibody using a WHO-prequalified rapid test (SD BIOLINE Dengue Duo) were used to confirm dengue illness. Summary (max 100 words): Diagnostic accuracy was determined, and independent predictors were identified using multivariate logistic regression. Results: Dengue prevalence was 42.2% (76/180) in a total of 180 studied individuals. Myalgia was reported in 93.4% vs 68.3% in dengue-positive than dengue-negative patients (p<0.001) revealing a high sensitivity (93.4%) but low specificity It was the prevalent symptom/sign among both cases and controls (Table 2A). Myalgia (≥5 score) had a specificity 55.8%. Chills were less predominantly observed among dengue-positive patients (44.7% vs 71.2%, p<0.001) and had moderate specificity 71.2%. In multivariate analysis, myalgia was a strong independent predictor (aOR=5.87, 95% CI: 1.99–17.29), while chills were inversely associated with dengue (aOR=0.41, 95% CI: 0.21–0.80). Conclusions: Severe myalgia is a sensitive clinical marker, whereas chills should raise the possibility of other causes. Targeting such symptom presentations can help contribute to early clinical suspicion and prioritize testing in the outpatient settings affected by dengue epidemics.