DENGUE HEMORRHAGIC FEVER

By Gary M. White, MD


Dengue hemorrhagic fever (DHF) is an infectious disease caused by any of four mosquito-transmitted virus serotypes.

Two phenotypes

The disease has been divided into two types, uncomplicated dengue and severe dengue (previously dengue hemorrhagic fever). Severe dengue occurs in patients with previous exposure and immunity to different dengue serotype.

Clinical

Many patients experience a prodrome for 2-3 days of chills and facial flushing. Then there is the sudden onset of fever, headache, myalgias, nausea, and vomiting. Retro-orbital pain is typical and myalgias may be severe giving rise to the nickname "Breakbone fever". The typical patient has 2 days of fever and other symptoms before the rash appears. The dengue rash is diffuse and appears as a sea of red with white islands of sparing.

Biphasic Pattern

Uncomplicated dengue lasts for 2-7 days with a small fever peak at the end. The fever will abate for a day and then return, a pattern that has also been called saddle back fever (aka "bi-phasic pattern"). Additionally, a second rash (usually morbilliform) may occur within 1-2 days of defervescence, lasting 1-5 days

Severe Dengue

In severe dengue, signs of plasma leakage appear as the fever breaks. Bleeding from sites of trauma, gastrointestinal bleeding, and hematuria may be present. Abdominal pain, vomiting, febrile seizures (in children), and a decreased level of consciousness have all been reported. In severe cases, the patient may go on to dengue shock syndrome.

Diagnosis

Acute and convalescent-phase serum samples should be sent to the CDC’'s Dengue Branch.

Treatment

There is no specific treatment for dengue fever. Patients should be monitored for hypotension, hemoconcentration and thrombocytopenia. Only acetaminophen should be given as NSAIDs can potential bleeding.

A penatavalent vaccine is available (Dengvaxia).

References

A sea of red with white islands of sparing. Steady Health
Toquesonmoto

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