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A.D.A.M. Medical Encyclopedia.
Dengue hemorrhagic fever
Hemorrhagic dengue; Dengue shock syndrome; Philippine hemorrhagic fever;
Thai hemorrhagic fever; Singapore hemorrhagic fever

Last reviewed: December 7, 2010.

Dengue hemorrhagic fever is a severe, potentially deadly infection spread
by certain species of mosquitoes (Aedes aegypti).

See also: Dengue fever
Causes, incidence, and risk factors

Four different dengue viruses are known to cause dengue hemorrhagic
fever. Dengue hemorrhagic fever occurs when a person catches a different
type dengue virus after being infected by another one sometime before.
Prior immunity to a different dengue virus type plays an important role
in this severe disease.

Worldwide, more than 100 million cases of dengue fever occur every year.
A small number of these develop into dengue hemorrhagic fever. Most
infections in the United States are brought in from other countries. It
is possible, but uncommon, for a traveler who has returned to the United
States to pass the infection to someone who has not traveled.

Risk factors for dengue hemorrhagic fever include having antibodies to
dengue virus from prior infection and being younger than 12, female, or

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 may appear as tiny spots of blood on the skin (petechiae) and
larger patches of blood under the skin (ecchymoses). Minor injuries may
cause bleeding.

Shock may cause death. If the patient survives, recovery begins after a
one-day crisis period.

Early symptoms include:

    Decreased appetite



    Joint aches

    Muscle aches


Acute phase symptoms include:

    Restlessness followed by:


           Generalized rash


           Worsening of earlier symptoms

    Shock-like state

           Cold, clammy extremities

           Sweatiness (diaphoretic)

Signs and tests

A physical examination may reveal:

    Enlarged liver (hepatomegaly)

    Low blood pressure


    Red eyes

    Red throat

    Swollen glands

    Weak, rapid pulse

Tests may include:

    Arterial blood gases

    Coagulation studies



    Liver enzymes
    Platelet count

    Serologic studies (demonstrate antibodies to Dengue viruses)

    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)


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

    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

    Supportive care in an intensive care unit/environment

Expectations (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.


    Liver damage

    Residual brain damage



Calling your health care provider

Call your health care provider if you have symptoms of dengue fever and
have been in an area where dengue fever is known to occur, especially if
you have had dengue fever before.
There is no vaccine available to prevent dengue fever. Use personal
protection such as full-coverage clothing, netting, mosquito repellent
containing DEET, and if possible, travel during periods of minimal
mosquito activity. Mosquito abatement programs can also reduce the risk
of infection.

Read More

    Dengue fever
    Immune response

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