Dengue fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome

Dengue fever  occurs in tropical countries predominantly in urban and in semi-urban areas.There are dengue epidemics time to time in those countries, especially after rains. Dengue fever is caused by four types of related viruses. One type of virus, which causes the disease on one occasion, does not offer protection against subsequent infections by any of the other three. There is evidence that infection by a second or third virus increases the risk of the complications referred to below (DHF & DSS). The virus is transmitted from man to man by mosquitoes, which breed in containers where water collects. The mosquito that conveys this infection is mainly the one called Aedes egypti, Aedes albopictus being the other one. Aedes mosquitoes are generally small in size. They are dark in color and have white spots and bands on parts of the body and legs. These characteristic markings on their bodies look like the stripes of a tiger. They bite only during daytime especially during morning and evening. Features of the infection. The illness may present with high fever lasting 4 to 6 days; sometimes the fever is moderate and subsides in 3 to 4 days. Other features include: severe aches and pains of the body (“breakbone fever”), tearing from the eyes, red eyes, nausea, vomiting and a loss of appetite. In some cases a rash may appear after a few days, and there may be slight enlargement of the lymph glands. 

Dengue Hemorrhagic Fever (DHF) occurs mainly in children, occasionally in adults. It is reckoned that one out of 200 patients with dengue fever may develop this condition. The early features include mild bleeding in stomach, bowel, nose, eyes and gums. This may result in vomiting, described as "coffee ground‘, because the vomitus looks like brewed coffee; dark tarry stools may occur. In some patients there are tiny bleeding points in the skin. The liver is enlarged unlike in Dengue fever.

 At this stage, fluid may pass through the blood capillaries into the tissues around them; this causes a state of shock. This complication is called the Dengue Shock Syndrome (DSS). In this condition there are many complications in the brain, kidneys,heart and circulation. These complications may result in death in 24 - 48 hours. Dengue Shock Syndrome can occur without Dengue Hemorrhagic Fever. Temperature drops, but the child is more ill, cold, clammy, and pale, with a rapid low volume pulse. Rush to hospital.

Laboratory investigations

A platelet count below 100,000, and an increase of the Packed Cell Volume (PCV) by 10-20%, supports a diagnosis of the disease. Dengue antibodies can be done but it’s not necessary as the Dengue Hemorrhagic Fever is a clinical diagnosis. If the patient is going into Dengue Hemorrhagic Fever, inward hematocrit must be done every 2-4 hours apart depending on the patient’s condition to monitor degree of capillary leakage and hemodynamic state of the patient.

Treatment of Dengue Hemorrhagic Fever

There is no specific treatment for Dengue Hemorrhagic Fever and Dengue Shock Syndrome. It is mainly supportive treatment with careful fluid management. Patient must be on isotonic solution and it must be correlate with capillary leakage. Too much fluid may cause fluid overload and can kill the patient especially by pulmonary edema.