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    Dengue hemorrhagic fever

    Hemorrhagic dengue; Dengue shock syndrome; Philippine hemorrhagic fever; Thai hemorrhagic fever; Singapore hemorrhagic fever

    Dengue hemorrhagic fever is a severe, potentially deadly infection spread by mosquitos, mainly the speciesAedes aegypti.

    Causes

    Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person is bitten by a mosquito that is infected with the virus.

    There aremore than 100 million new cases of dengue fever every year throughout the world. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus froman earlierinfection and being younger than 12, female, or Caucasian.

    Symptoms

    Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever. But after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock-like state.

    Bleeding appears as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries cancause bleeding.

    Shockcanlead tdeath. If the patient survives, recovery begins after a one-day crisis period.

    Early symptoms include:

    • Decreased appetite
    • Fever
    • Headache
    • Joint or muscleaches
    • Malaise
    • Vomiting

    Acute phase symptoms include:

    • Restlessness followed by:
      • Ecchymosis
      • Generalized rash
      • Petechiae
      • Worsening of earlier symptoms
    • Shock-like state
      • Cold, clammy extremities
      • Sweating

    Exams and Tests

    A physical examination may reveal:

    • Enlarged liver (hepatomegaly)
    • Low blood pressure
    • Rash
    • Red eyes
    • Red throat
    • Swollen glands
    • Weak, rapid pulse

    Tests may include:

    • Arterial blood gases
    • Blood tests (find signsof the virus in the blood)
    • Coagulation studies
    • Electrolytes
    • Hematocrit
    • Liver enzymes
    • Platelet count
    • Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengue antigen)
    • Tourniquet test (causes petechiae to form below the tourniquet)
    • X-ray of the chest (may demonstrate pleural effusion)

    Treatment

    Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms.

    • A transfusion of fresh blood or platelets can correct bleeding problems
    • Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances
    • Oxygen therapy may be needed to treat abnormally low blood oxygen
    • Rehydration with intravenous (IV) fluids is often necessary to treat dehydration
    • Supportive care in an intensive care unit/environment

    Outlook (Prognosis)

    With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive.

    Possible Complications

    • Encephalopathy
    • Liver damage
    • Residual brain damage
    • Seizures
    • Shock

    When to Contact a Medical Professional

    Seeyour health care provider right away if you have symptoms of dengue fever and have been in an area where dengue fever occurs, andespecially if you have had dengue fever before.

    Prevention

    There is no vaccine to prevent dengue fever. Use personal protection such as full-coverage clothing, mosquito nets, mosquito repellent containing DEET. If possible, travel during times of the day when mosquitos are not so active. Mosquito abatement (control)programs can also reduce the risk of infection.

    References

    Haile-Mariam T, Polis MA. Viral illnesses. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 128.

    Lupi O. Mosquito-borne hemorrhagic fevers. Dermatologic Clinics. 2011;29:33-38.

    Vaughn DW, Barrett A, Solomon T. Flaviviruses (Yellow Fever, Dengue, Dengue Hemorrhagic Fever, Japanese Encephalitis, West Nile Encephalitis, St. Louis Encephalitis, Tick-Borne Encephalitis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 153.

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    • Antibodies

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      A Closer Look

        Talking to your MD

          Self Care

            Tests for Dengue hemorrhagic fever

              Review Date: 11/10/2012

              Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

              The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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